Often when we talk about mass casualty incidents (MCIs) and active killer incidents the topic of casualty collection points (CCPs) come up; unfortunately, they are merely a topic of discussion. I believe CCPs are a greatly under utilized asset in relation to active killer incident response and management. On emergency scenes with multiple casualties, providers and resources are typically divided instead of patients and casualties being consolidated. This process goes against everything we are taught on how we should conduct ourselves during an MCI, yet we continue to do it. With a major goal of TECC being to reduce additional injuries, how can this be accomplished with security and medical assets being divided in an ineffective way? It is imperative that all emergency responders, including law enforcement, are familiar with CCP selection and operations.
CCP Site Selection and Operations
I often equate CCP site selection to picking the perfect camping site; you want protection, drainage and routes of ingress and egress at a minimum. CCPs can be predetermined or field expedient. Predetermined CCPs can be selected during the planning phase of tactical operations — high-risk warrants, barricaded suspects, hostage rescue, etc.; this is where the tactical medics input and knowledge come into play as they integrate with law enforcement elements.
CCPs can be in an open field near the incident site, an adjacent building, or in a secured section of the incident site. A secured section of the incident site will more than likely be the site of a field expedient CCP. This section should provide the above mentioned qualities but also be large enough to expand should the number of casualties increase. When determining the location of a CCP, casualty evacuation routes and platforms must be considered. Is the CCP in a location where ambulances and emergency vehicles can easily ingress and egress? If your CCP is on a second story is it best to carry casualties downstairs or take them out a second story window? These are elements that must be taken into consideration when selecting a proper CCP site.
In consolidating casualties to a CCP, responders are able to provide adequate security, triage, treat and begin transporting casualties from these scenes. Security elements should be dedicated to the CCP, in a dynamic situation a lapse in security could have hazardous results. A senior medical provider, not necessarily the highest educated but highest experienced, should perform the role of the triage officer. As the triage officer sorts casualties into the standard S.T.A.R.T. triage categories, at least one ALS provider should be assigned to these casualty categories.
Casualties should also be placed within the CCP with the most severely injured — immediate casualties — in a position to be evacuated first and the least viable casualties — expectant casualties — towards the rear of the formation. Aid and litter teams comprised of LEOs and BLS providers can assist in casualty treatment and evacuation.
As with any incident, communication is key. Not just communication within the CCP but also communication with incident commanders and medical treatment facilities. Communication helps to ensure that casualties receive appropriate treatment, accountability is maintained, and casualties are evacuated to appropriate facilities. Above all it is important to remember that CCPs are an often overlooked asset in response to active killer/MCIs and should be regularly trained on with all emergency responders.