The Good Samaritan: Integrating Ordinary People into Emergency Response
The real first responders in a widespread destructive incident are those who are immediately on hand, including the survivors.
In 1942, when fire raged through the Cocoanut Grove night club in Boston, there was an urgent need for transportation of the injured and dead. Some were moved in taxis, and many were transported in newspaper delivery vans.
In 1987, after a tornado tore apart large areas of Edmonton, Alberta, residents of a trailer park used their undamaged cars to take injured survivors to hospital.
In 1995, survivors of the Kobe earthquake collected the bodies of the dead and took them to temples and other public buildings.
In 1998, when Swissair 111 plunged into the Atlantic Ocean five miles offshore from Halifax International Airport in Nova Scotia, the first response was by fishing boats from nearby coastal communities.
In 2004, after the Indian Ocean tsunami struck Thailand and Sri Lanka, survivors picked up bodies and took them to hospitals, temples and morgues.
These examples illustrate the well-documented fact that the real first responders in a widespread destructive incident are those who are immediately on hand, including the survivors. Police, firefighters and EMS personnel play little, if any, role in initial response.
The Impact of Civilians and Survivors
What is not so well documented, and is less understood, is the impact of these Good Samaritans' actions on emergency response.
For example, survivors are rarely equipped to do heavy search and rescue, so the people they look after and take to medical centres are usually the least injured. The result is what might be called "reverse triage": medical centres are inundated first by those least in need of immediate medical attention.
Or to take another example, the fact that survivors leave the impact area with the injured means that when emergency personnel do arrive, there is no one to tell them what has been done and most important who has gone where with whom.
Occasionally, emergency personnel arrive in time to co-opt civilians and make them part of the response.
For example, when an Air Ontario plane crashed in the bush near the airport of Dryden in northern Ontario in 1989, most survivors walked out to a nearby road, where they stood cold and wet and in some cases dripping of jet fuel.
An Ontario Provincial Police sergeant told drivers of civilian vehicles to load up with victims and take them to hospital. He even loaded several slightly injured into a garbage van.
In Edmonton in 1987, Royal Canadian Mounted Police told drivers to use their cars as ambulances. One driver protested that the blood would stain his lovely white leather seats. He was told to do it anyway.
In Nova Scotia in 1998, Royal Canadian Navy ships communicated with the fishing boats, directed them into search lanes and asked them to bring any human or aircraft debris to them, rather than take it to shore.
Sometimes emergency personnel even find imaginative ways to use people. After a building collapse in my home city of Ottawa, Ontario, police used public works employees (who wear distinctive gear) for perimeter security.
How to Plan, not Just React
While all these actions made sense, they were not part of any plan. Given the frequency of involvement of ordinary citizens in emergency response, it would seem to make sense to build that response into the plan or, to put it another way, to develop plans based on what happens, not on what officials would like to happen.
Hospitals, for example, should assume that the first injured to arrive will be those least injured and have plans to move them away from emergency. But hospitals should do something else: they should have clerical staff assigned to take the names of Good Samaritans so they will be able to inform personnel doing search and rescue who is safe.
But planning can go much further than this.
When the Ottawa Police Service asked what senior citizens could do in an emergency, I suggested they be asked to keep track of who was at home and who was away and who was rescued and who rescued them and, most important, who had not been rescued and therefore might still be trapped in wreckage.
When Dr. Erik Auf der Heide and I studied the problems of dealing with chemically contaminated victims, we realized two things: first, that some victims will reach hospital before the hospital knows there has been an incident; and second, that the Good Samaritans who assist contaminated victims may be disoriented by fumes as they drive them to hospital.
This led to two suggestions.
One was that a hospital which receives contaminated victims should immediately alert all other hospitals in its area so they can take preventative measures. The other was that as soon as an incident becomes known, warning messages should go out over radio and through Amber Alert systems so drivers will recognize the risks.
The issue, of course, is not whether these suggestions make sense, but whether planners accept what will actually happen in emergencies and plan accordingly. From what I have seen, that is often not the case.
Most emergency plans assume that an incident will be at a site, and that this site will soon be controlled by police, and that firefighters will deal with fires, spills and heavy rescue, and EMS personnel will triage the injured, sending them in an orderly way to the appropriate medical center. There is also an assumption of command and control.
Such a plan may work at an air crash or train wreck, but it makes little sense after a widespread destructive incident.
I say "may" work, because after an Air France Airbus A-340 ploughed off a runway at Toronto International Airport in August 2005, civilians picked up passengers and in some cases took them to where they had planned to go, even though the plane had never cleared Customs.
Surely it's time emergency planners accepted that ordinary people will play a role in disaster response and look for ways to work that into their plans and take advantage of that activity. It no longer makes sense to have plans that state (like one I saw recently) that under no circumstances must civilians be allowed to play any role in the response.
Perhaps that is in fact starting to happen.
Last December, I was asked to lecture in Amsterdam on the role of ordinary people in emergency response. I was invited by local government and the Amsterdam fire department, which not only takes an imaginative approach to emergency planning, but considers it has a response to educate others. The invited audience came from all over The Netherlands.
To avoid someone misinterpreting this column, let me make clear I am not suggesting that emergency response be turned over to amateurs.
Firefighters will still be needed to do search and rescue. EMS personnel will still be needed to assist and transport the more seriously injured. Police will still be needed to assist the movement of personnel to and from an impact area.
Hospitals will still have to receive and treat the injured. Social service and voluntary agencies will still be needed to assist persons locating displaced victims and providing covering and clothing, sustenance and food, shelter and accommodation.
However, all these agencies should individually and together think how the actions of ordinary people can be integrated into their planning and response.