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Lessons Learned

Lessons Learned

“

“

Joint Emergency Response Exercise” Munich

Joint Emergency Response Exercise” Munich

International Airport

International Airport

LT COL JUERGEN K. KNUEPPEL, MD

HQ AIRNORTH

Ramstein AB

NATO/CAPC Joint Civil / Military Exercise

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NATO

SC

NATO FORCE HQ in THEATRE

MEDCC

JTCC

MJLC

CECC

SCEPC/CAPC

AMCC

N

A

T

I

O
N

S

Civ AE Assets

Mil AE Assets

AIR

- - - - -

AECC

LAND
SEA

PECC

N
A

T

I

O
N

S

NMLT

IEF

AECO

CSU

AECO

OMF

AECO

OMF

AECO

XX

XXX

Command/Control

Coordination/Liaison

OMF: Originating Medical Facility

OMF: Originating Medical Facility

CSU: Casualty Staging Unit

CSU: Casualty Staging Unit

IEF: In-transit Evacuation Facility

IEF: In-transit Evacuation Facility

AECO: AE Coordinating Officer

AECO: AE Coordinating Officer

PECC: Patient Evac Coordination Centre

PECC: Patient Evac Coordination Centre

AECC: AE Control Centre

AECC: AE Control Centre

NMLT: National Medical Liaison Team

NMLT: National Medical Liaison Team

Senior Civil Emergency Planning Committee
Civil Aviation Planning Committee
Civil Emergency Crisis Cell

Strategic Command (I.e. SHAPE)
Air Movement Control Center
Multi Joint Logistic Center
Joint Transport Coordination Cell

Ref.: NATO / EAPC 1999

Chapt 3, Med Evac

Concept

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Overview

• Exercise Set Up

by Civ / Mil Working Group / “at night”

• Exercise Objectives

prepared together with HQ AIRN

•

• Lessons Learned

• Recommendations

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History:

• ICAO:

Airport Emergency Exercises

required

• Example

“Bali Terror Attack 02“

• NATO/CAPC (Civil Aviation Planning Committee)

• Civilian Airport :

Civil / Military Scenario!

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Anticipated Scenario

Anticipated Scenario



Ge C 160 AeroMedEvac AC

Ge C 160 AeroMedEvac AC
30 patients on its way to Cologne



US C 130 AeroMedEvac AC

US C 130 AeroMedEvac AC
40 patients on its way to Ramstein

–

Have to divert to

Have to divert to

MUNICH INTERNATIONAL AIRPORT

MUNICH INTERNATIONAL AIRPORT



Airport alarmed Emergency Services
to care for patients

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Objectives

Objectives



Alarming the Services

Alarming the Services



Execute Alarm Plans

Execute Alarm Plans



Rescue Coordination

Rescue Coordination

Cell

Cell



ICU Ambulances

ICU Ambulances



Command and Control

Command and Control



Radio Communication

Radio Communication



Airport Coordination

Airport Coordination



Base Operations

Base Operations



Fire Department

Fire Department



Patient Retrieval

Patient Retrieval



Patient Tracking

Patient Tracking



Multinational Issues

Multinational Issues



Language barriers

Language barriers



ICU Patients

ICU Patients



Timely Responses

Timely Responses



Diplomatic Issues

Diplomatic Issues



Mil Ops, Chaff & Flares

Mil Ops, Chaff & Flares



Ammunition & Weapons

Ammunition & Weapons



Military Procedures / Regs

Military Procedures / Regs



Security

Security



Safety

Safety



Basic Human Life Support

Basic Human Life Support



Medical Coordination

Medical Coordination



Media, Public Interest

Media, Public Interest

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Media, Public Interest

Media, Public Interest



Media

Media

– Numerous agencies
– Too little guidance



Television

Television

– Focused on “Problems”
– To little continuous INFO from Authorities



Airport Press Conference

Airport Press Conference

– Was well prepared, little details!



Recommendations:

Recommendations:

– More professional Guidance and

Preparation!

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Alarming the Services

Alarming the Services

Execute Alarm Plans

Execute Alarm Plans

Rescue Coordination Cell

Rescue Coordination Cell



Professional Set Up!

Professional Set Up!



Initial Time

Initial Time

– Response Sufficient



RCC Build Up

RCC Build Up

– Delayed, due to on Base Driving

Restrictions

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Lessons Learned

Lessons Learned



Plans

Plans

–

Not adjusted to structures

Not adjusted to structures

– I.e.Telephone Numbers

–

Not adjusted to possible scenarios

Not adjusted to possible scenarios

– Regional RCC
– INFO Management



Recommendation

Recommendation:

– Train professional leadership

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ICU Ambulances

ICU Ambulances



Local ICU Airport Services

Local ICU Airport Services

(initial)

(initial)

– Cooperation with Fire Department



Regional ICU Ambulances

Regional ICU Ambulances

(later)

(later)

– Large numbers of teams
– Good Equipment
– Motivated Personnel
– Command and Control (C2) has to be

improved

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Patient retrieval

Patient retrieval



Patient Retrieval

Patient Retrieval

– Took too long
– Complicated Rules



Services

Services

– Conservative slow Thinking



Coordination between services

Coordination between services

– Has to be improved

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ICU Patients

ICU Patients



Handling

Handling

– Was basically good
– ICU patients were professionally

transported

– to Key Hospitals



One ICU Patient

One ICU Patient

– Ran out of Oxygen
– Stayed on AC for more than one hour

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Command and Control

Command and Control

Radio Communication

Radio Communication

Airport Coordination

Airport Coordination



Personnel and Equipment

Personnel and Equipment

–

Regional Services in place



Leadership

Leadership

(from outside)

(from outside)

–

Important ISSUE

–

Federal State Commander

–

Airport Coordination essential



RadioComs

RadioComs

–

No RADIO COMS possible

–

due to big Technical Problems on Airport /

Interferences



Coordination:

Coordination:

–

To be improved

!

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Specific Military Issues

Specific Military Issues



Emergency Stop of C 130 AC Engines

Emergency Stop of C 130 AC Engines

- Ambulances and People came to close to AC



Responses to

Responses to

- Ammunition, Weapons

(awareness improvement)

- ICU Patient

(Procedure: Emergency Oxygen release)

- Chaff / Flares

Issue not sufficiently addressed



Recommendations

:

Military Liaiason

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Language barriers

Language barriers



Language Barriers:

Language Barriers:

–

English Communication skills not sufficient !

– When it comes to Medical / Technical details



Recommendations:

Recommendations:

– Awareness / Training
– Checklists

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Diplomatic Issues

Diplomatic Issues



Reach Back to Consulate

Reach Back to Consulate



Reporting to local Authorities

Reporting to local Authorities

– Has to be considered
– Leadership Checklist

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Patient Tracking

Patient Tracking



Patient Data

Patient Data

–

Were assembled, but

Were assembled, but

–

Were not available(procedure change)

Were not available(procedure change)

–

Police had no data

Police had no data

–

No Pat Tracking

No Pat Tracking

(Military Commander had no Overview)

(Military Commander had no Overview)



Recommendations:

Recommendations:

– Professional Tracking Process
– Use local RCC in MUNICH

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Basic Human Life Support

Basic Human Life Support



Essential Issues lacking during the

Essential Issues lacking during the

operation

operation

– Toilettes (

not on scene available)

– Warm shelter

(Patients waited in Cold > 30

minutes)

– Information to patients

(Lacking)

– Provisions for walking patients
– Food/Drinks
– Translators
– Facilitators, Priests
– Liaison Teams, Contacts

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“

“

Security”

Security”



Important Issue!

Important Issue!

– For Entering Airport
– To be anticipated!

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Summary Recommendations

Summary Recommendations



Update

Update

Emergency Plans

Emergency Plans



Military /

Military /

Medical Liaison Team

Medical Liaison Team



Computer Aided Table Top Exercises /

Computer Aided Table Top Exercises /

CAX

CAX



Modern C2

Modern C2

Procedures /

Procedures /

Radio

Radio

Equipment

Equipment



Professional (on scene)

Professional (on scene)

Leadership

Leadership

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Comments / Questions . . . ?

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