How to Respond to a Mass Casualty Incident

In the United States, the number of mass casualty incidents has been climbing steadily over the years. Are we prepared to respond?

The sharp increase in mass casualty incidents has made it imperative to have proper training, plans, and protocols in place to respond. In the United States, the number of mass casualty incidents—events that overwhelm local resources and response capabilities, which can range from acts of terrorism to active shooter incidents to destruction from natural disasters—has been climbing steadily over the years. The question is, are companies prepared to respond? 

Global Guardian recently hosted a webinar during which panelists offered advice gleaned from years of professional experience of emergency preparedness and how to respond to mass casualty incidents. The panelists included Michael McPherson, special agent in charge of the FBI’s Tampa field office; Kathryn M. Turman, former assistant director over the FBI Victim Services Division; and Global Guardian CEO Dale Buckner. Mike McGarrity, vice president of Global Risk Services at Global Guardian, moderated the discussion. 

The webinar touches on advice for responding to a mass casualty event, triage, and caring for victims. Watch the webinar below, or read on for the insights.  

7 Recommendations for Responding to a Mass Casualty Incident 

At the FBI, McPherson has led the bureau’s efforts to secure mass gatherings, including the Super Bowl. He was also part of the response to the 2017 mass shooting in Las Vegas in which a gunman killed 60 people and wounded 411. 

In 2020, the FBI recorded 40 active shooter incidents in the United States. More than 60 percent of those incidents took place in the “commerce arena,” said McPherson. He suggested some ways companies can better respond to such incidents: 

1. Ensure fact-based communications: Initial reports following an incident “are almost always wrong,” McPherson said, emphasizing the importance of fact-based communications. “Communications is constantly our Achilles’ heel,” he said, noting that this is something both law enforcement and the private sector constantly struggle with. He suggested information should be properly sourced and that it be logged in real time. “A loss of narrative can mean a loss of confidence,” not just among employees but also the public, said McPherson. “If you don’t know the facts you should not be stating them as such because that will come back and haunt you.” He recommended any public communications be coordinated with law enforcement. 
2. Provide clear guidance to employees: At the time of an incident, employees should be provided clear instructions on how they should respond—whether to shelter in place or evacuate, for example. A responsible party in the organization should be designated to provide this information. 
3. Facilitate law enforcement response: The law enforcement response to an event will always be overwhelming. McPherson suggested companies anticipate such a response and establish a forward command post to assist law enforcement. For example, he said, many first responders typically would not know the layout of an office space or how to access a particular section of a building. He recommended providing law enforcement “go bags” that include access cards, maps, and contact numbers so that they can move through the facility easily. Toward this end, Buckner said it was important to ensure security systems are integrated and that a company’s guards have access to security camera monitoring. 
4. Set expectations: Once a mass casualty incident is over, it can take hours for law enforcement to go in and secure the site and ensure that all threats have been eliminated. McPherson said this process can appear to be “excruciatingly slow,” but it is “thorough.” 
5. Know the plan: Emphasizing the importance of all employees being well versed in an emergency response plan, McPherson said planning for emergencies is something most organizations overlook. “Trying to account for your people is always a challenge for us as we get to the response,” he said. McPherson said it is important for companies to have the “right people” in place at the time of an incident, for systems to be synchronized, and the ability to identify single points of failure—people who may be affected by the incident—and address this issue by putting in place capable backups. 
6. Build a timeline: McPherson recommended building a timeline that covers the first reports of the incident up to the response. This timeline, which he described as the “backbone” of a law enforcement investigation, will help weed out inaccurate reporting. Buckner reiterated the importance of collecting data. 
7. Prepare for disruptions: A mass casualty incident could result in a facility to be shut down for an extended period of time to allow investigators to work on site. During the investigation, investigators will also need access to phone logs, CCTV footage, and personnel. McPherson said companies should consider this eventuality and what such a disruption would mean for their operations. 

“You can’t prepare for everything… but what are the most likely scenarios based on the intelligence? So, if you’re not doing your homework on the intelligence, you can’t prepare the plan,” said McPherson. As a result, he said, it is important for companies to understand the threat environment, acknowledge their limitations, and then leverage partner resources to fill those gaps within their cost structure. 

Buckner said it is critical that companies—if they have not already done so—put on their calendar plans to train and rehearse for a mass casualty incident in the second and third quarters of next year. 

Eventually, Buckner said, corporate leadership cannot hide in the event of a major incident. 

“This is really, really difficult and you will not be perfect and you will make mistakes. But my advice… is don’t try and hide from it, take it head on, be out there, figure out your plan, know it, and be very aggressive.” 

Understanding Triage: Prioritizing Medical Care 

During a mass casualty incident, emergency responders and medical professionals utilize a process called triage to prioritize and allocate medical care efficiently. Triage involves quickly assessing and categorizing victims based on the severity of their injuries or medical conditions and probability of survival. At the scene of the incident, emergency responders, such as paramedics, firefighters, or other trained personnel, perform initial triage. Upon arrival at the hospital, another level of triage takes place. Medical staff, including doctors, nurses, and other medical professionals, reevaluate each patient based on more comprehensive assessments and available resources. 

As a bystander or victim, understand that you should not attempt to perform triage on patients yourself. Instead, focus on providing whatever assistance you can to ensure a safe environment while waiting for emergency responders to arrive. Here's what you need to know about triage: 

• Assessing severity: During triage, responders evaluate victims to determine the seriousness of their injuries or medical needs. They prioritize those who require immediate attention, ensuring critical care is provided promptly. 
• Tagging system: Triage often involves using a color-coded tagging system to categorize victims. These tags indicate the urgency of medical attention required. However, please note that only trained professionals should handle this process. 
• Resource allocation: Triage helps responders make informed decisions about allocating available medical resources effectively. By prioritizing care based on severity, they can maximize the number of lives saved and provide appropriate treatment promptly. 

Remember, triage is a complex process handled by trained professionals. Your role as a bystander is to seek safety and wait for the arrival of emergency responders, who will apply their expertise to provide the necessary medical care based on the severity of injuries. 

Advice on Caring for the Victims 

In her capacity as assistant director of the FBI’s Victim Services Division, Turman was involved in major mass casualty events between 2002 and 2020, including the 2007 Virginia Tech shooting, the 2013 Navy Yard shooting in Washington, DC, and the 2019 shooting at a Walmart in El Paso, Texas. She acknowledged the challenges that arise when employees have been affected by a mass casualty event. “The good news is you are not going to be alone. There are experienced organizations and agencies that will help you and help your people,” she said. 

Turman said it is important for corporations to identify who within the organization will be working with victims of mass casualty incidents—those directly affected by the incident as well as those who have been working with them in the post-crisis period. “Every event is going to present unique issues, but the needs of victims are mostly predictable,” said Turman. “Eighty-five percent of what most victims need and want in the aftermath is information,” she added.  

Like McPherson, Turman, too, emphasized the importance of accurate and reliable information. 

“Providing practical assistance in a compassionate manner can make a huge difference in how your people cope and in how they view the overall experience,” she said. 

Turman offered the following suggestions: 

• Employers should encourage their employees to regularly update their next of kin information. Families should also know how to contact the employer in the event of an emergency. 
• Employers should quickly activate a communication channel with victims and their families in the event of an incident. 
• Internal care team members should be carefully selected and well trained. “They need the right skills and personalities to serve in these demanding roles,” Turman explained. 
• The FBI’s Victim Services Division can provide or identify resources to help with common support services, including emergency travel, medical evacuation, repatriation, emergency child care, replacement of damaged or lost documents, psychological first aid, funeral and burial assistance, and short and long-term mental health and grief counseling. 

Eventually, Turman said, survivors are looking for an acknowledgement of their loss. “It needs to be human and very personal,” she said. “They desperately hope for someone in charge to tell them there is a system in place to care for them and to help them find their way through the tragedy.” 

“Providing effective and timely support to victims will go a long, long way to building resilience in your employees, their families, and the organization,” she concluded. 

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