On August 31, 1988, a Boeing 727 crashed at Dallas International Airport, very near the perimeter fencing. Responding airport fire and EMS personnel set up a triage sector at the accident site. EMS units from neighboring counties and other jurisdictions approached the scene from outside the airfield. The Incident Commander, who was the person in charge of airport emergency services, was not informed when a second triage area was set up 250 yards away by local EMS responders.

This lack of coordination created a serious breach of proper response activities, and in the accounting and identification of victims. Further, it endangered the safety of airport rescuers, who were searching for passengers already evacuated.

The way to surmount these difficult tasks is to utilize the Incident Command System (ICS). ICS is an on-scene management tool used by most fire departments and many other government agencies.

Even the upcoming NFPA Standard 1600, "Emergency/Disaster Management and Business Continuity Programs," mandates that "an incident management system shall be utilized to direct, control, and coordinate response operations."

Fire departments are especially familiar with ICS, and most have used it for years. Their success in incidents ranging from a trash can fire to a thousand-acre blaze depends heavily on its use. Therefore, EMTs/paramedics within the fire service have been educated and trained to use ICS regularly. This is not the case with many other ambulance providers. The ICS concept is seldom used in single medical emergency responses. The daily activities are handled by independent ambulances, staffed with two or -if they are lucky- with three EMTs, who do their jobs focusing on a single patient and not on the ICS concept.

In a major disaster, freelancing actions can endanger emergency personnel and others, and may even interfere with on-site activities.

EMS professionals need to understand the big picture as well as their rules and responsibilities. They must know who they report to (e.g., incident commander, liaison officer, operations chief, staging officer) in order to get assignments and to ensure well-coordinated and effective performance.

Treating and transporting patients outside an Incident Management System will create chaos and confusion. Without coordination, some hospitals may become overwhelmed by receiving too many patients, while other trauma centers may have underutilized capabilities.

If there is no single check point to keep track of every patient's destination, victims will get lost. In the ICS model, all ambulances are documented by a designated EMS-transportation officer noting the name, location, status, and destination of each victim.

EMS programs must be prepared to meet these challenges. The knowledge of ICS and the skills to use it properly will improve the capabilities of every provider. It will enable them to have competency in a major emergency situation and, therefore, better serve their communities, their customers, and even their shareholders.

Even if you don't get along with your competing or neighboring EMS company, you are going to be working with them on large-scale emergencies. The victim's need for fast and proper attention is what's most important. Mutual aid agreements should describe the need for common ICS training, as well as procedures for exercises on a regular basis. Fire departments should provide ICS training for allied EMS groups.

Multi-casualty disasters will continue to occur. This is inevitable due to increasing populations, expanded high-speed mass traffic systems, and more people living in high-risk areas. The means to obtain sufficient EMS resources to cover potential hazards must be developed in advance.

As always, teamwork is the key to success. While working with other, mutual aid, or even competing agencies, the ability to communicate and coordinate efforts is essential. ICS is the common language. Everyone in the disaster response family must speak and understand it fluently.