BEIRUT: The car bomb that exploded Thursday in a southern suburb of Beirut, the latest in a series of security incidents, has thrown into sharp relief the need for a cohesive and well-organized system of emergency response.
Sources from the Red Cross, Civil Defense and local hospitals agree that emergency response to mass casualty incidents is hampered by two major problems: the absence of a command structure and a corresponding lack of coordination and communication among the different agencies involved.
Dr. Mazen Sayed, director of emergency medical services and pre-hospital care at the American University of Beirut Medical Center, recently completed a research paper on emergency response in Lebanon.
“The main problems we found,” he says, “were [with] communication ... and [with] the command system that is in place. The disorganization is another problem. You don’t know which one is the lead agency ... The third part is we don’t know our resources. There hasn’t been a national assessment of the capabilities of the local agencies in terms of responding to disasters.”
In most instances, the Army is in charge of securing the scene of a bombing, earthquake, building collapse, fire, or other disaster involving mass casualties, the Civil Defense takes over search and rescue, and the Red Cross provides treatment and transportation of any wounded or dead.
In reality, however, the role of each agency is not clearly defined, resulting in chaos at the scene.
“What happens is everyone is deployed in parallel and you don’t know who is in charge,” Sayed explains.
“You don’t know who is doing what, and this is where the lack of coordination comes into place and you see a chaotic scene ... without clear coordination and organization.”
One of the problems faced by the Red Cross is how to quickly access a site amid crowds of bystanders. A source at the organization denied media reports claiming the response to Thursday’s bombing by emergency services had been delayed due to chaos at the scene, saying they were able to deploy 15 ambulances and 50 first-aid staff to the scene of the blast within minutes and had no problems in reaching the site.
Marwan Aawar, assistant director and head of district at the Red Cross’ EMS headquarters in Hazmieh, admits that organizing a speedy response is often difficult, however.
“Access is not easy,” he explains, “especially with the mentality of people in Lebanon. If there is a bomb anywhere [else] in the world people will try to be far from the place. Except here.”
Difficulties also arise when civilians at the scene try to aid the medical teams. Even for the smallest mass casualty incidents, he says, “we will ask a minimum of two ambulances to dispatch to the place, because [when] the first ambulance arrives, it will be out of control. People will be ready, waiting there, and when the ambulance arrives they’ll open the door, they’ll put as many injured and dying people as possible inside. It’s impossible for the volunteer to say, ‘No, no, you cannot do this and this.’ No one will understand and no one will listen.”
The Red Cross’ primary objective, he explains, is to move casualties to a safe zone where they can do a triage, assigning colors to the wounded to designate whether they are dead, dying, in need of urgent hospital treatment, or have minor wounds that can be treated on site.
They then use their internal communication system to contact their dispatch centers that tell them which hospitals are nearest and what capacity they have to treat victims.
Problems arise, however, when Civil Defense or other private organizations also deploy ambulances to the scene. With no system of communication between the agencies, they work independently of one another.
“We are aiming to have one triage space and to have an ambulance pool,” says Aawar, “because we don’t know where they are moving their patients. Let’s say our dispatch center tells us hospital X is ready to receive five patients and then Civil Defense brings the five. We will arrive and they will be [at capacity].”
“The problem when you have a bomb is that we have bad communication tools,” explains Aawar. “No mobiles, no telephones. We are [able to] communicate everywhere in Lebanon without any problem, because we have our own radios, which are not affected by anything. What we are doing with the hospitals now is trying to install the same system – to have radios in the ER so that we can communicate with them. In this way we are trying to minimize the problem – we cannot solve it.”
Civilians will often try to help evacuate victims from the scene, Aawar explains, adding to the confusion.
“It’s very difficult to tell a person ‘Look, don’t move this patient, leave it here, after 15 minutes someone will come and help,’” he says. “No one will understand that. Sometimes it happens that civilians arrive at the patient before us. We know that they are not ... transferring the patient in a good way, but we cannot blame them because they feel that they are doing something good.
Plans are in motion to improve the system, however. A senior source at Civil Defense told The Daily Star that in 2010 the government created a Crisis Management Center, designed to bring together representatives from every agency in a single operation room in case of a disaster, to ensure effective coordination. To date, however, no single incident has been deemed serious enough for the plan to be put into action.
Aawar believes that the only long-term solution is to create a large-scale government-led system of command and communication, to be adhered to in case of any emergency.
“If Civil Defense or the Red Cross or any other society says ‘I am the leader,’ no one will accept it,” he says. “So the only leader should be from the government. I went to Norway and I saw how they are managing this ... there is one dispatch center common for all – police, Civil Defense, fire department, Red Cross, hospitals, all in one room, and also doctors giving medical advice. This is the first step ... We should be in one room receiving one call ... Second, if there is no one leader for the whole site, it’s impossible.”
He says the Red Cross is in talks with the Army, Civil Defense and ministries to draw up a plan, but stresses that it will take time before it comes to fruition.
“Before having a government it’s impossible,” he says. “After the government [is formed] this will not be the priority. After this [becomes the] priority, it will take years, because there’s a lot of protocols, procedures and training, so not an easy issue.”