Under a clear blue sky on a warm November day, football players scrimmaged at Candlestick Park while the famous Gold Rush Girls performed cheerleading routines on the sidelines and the scoreboard flashed highlights from previous games.

A closer look, however, would reveal major incongruities. The players were not the former World Champion San Francisco 49ers, but rather the Burlington High School Football team, living their dream of playing at Candlestick, now known as 3Com Park. Even more significant was the smoke emanating from the eastern stands, where you could see the wreckage of a small plane surrounded by 200 people in various levels of morbidity or mortality, many covered in blood.

This was the scene as the San Francisco Fire Department conducted its largest-ever multiple-agency disaster drill as part of an ongoing disaster preparedness effort. Although people from the Bay Area could have chosen to do just about anything on this beautiful day, 650 of them spent the morning pretending to be injured or part of a frightened crowd experiencing a disaster.

One of the most difficult challenges facing public safety agencies is preparing for human-caused disasters, which may come in a limitless variety of possible scenarios. Now that we live in what many call a “post — Sept. 11 world,” attacks on domestic soil are considered a likely possibility.

To meet this challenge, it's necessary for multiple agencies to communicate and coordinate at an unprecedented level. The purpose of the exercise was to test the region's emergency responders, and underscore the training, communication and equipment needs for responders and policy-makers.

Pre-training exercises

A large-scale disaster drill is a necessary part of any effort to increase local capabilities by testing preparedness levels. While system demands, equipment availability and cost preclude participation by every member in a single large-scale event, such drills are vital teaching tools that yield significant lessons.

Exercises of this magnitude should include as many response agencies and members of the community as possible. Large exercises will draw the attention of the media and public, which may expect that the department already has inculcated the knowledge and skills required for handling such a scenario. In other words, learning from your mistakes may be both painful and public.

In the wake of recent world events, the San Francisco Fire Department has refocused many training and planning efforts and instituted a regimen of intensive disaster training. Within days of the attacks on New York and Washington, the department conducted educational modules aimed at updating the mass-casualty and disaster skills of every member of the department, focusing particularly on responder safety issues. These were followed within one month by citywide sessions that confronted each of the 10 firefighting battalions with a realistic mass-casualty scenario resulting from a terrorist assault.

The mass-casualty exercises of 2001 consisted of teaching sessions that addressed specific aspects of disaster response, followed by a one-hour scenario in which crews had to establish command as well as extract, triage, treat and begin transport of 20 to 30 victims injured in a pipe bomb blast.

This effort brought in about 400 volunteers over a 15-day period to play the role of the injured. During each of the two sessions per day, volunteers were moulaged and spread over two floors of an abandoned building that had been made to look like an office building cafeteria. Live victims were supplemented by more than a dozen old CPR mannequins, revitalized as props for disaster drills.

Practice makes perfect

Yearly modules addressing different aspects of the department's disaster response capabilities have become a codified part of San Francisco's training calendar, creating a need to test the effectiveness of these sessions. The department had emphasized exercises that required multiple battalions to work with outside agencies to handle a multifaceted event that included suppression, rescue, medical and crowd control components.

A large-scale drill was viewed as an ideal mechanism to test this system. While only a limited number of companies could participate in any one exercise, the involvement of multiple battalions provided a statistically significant sample that allowed policy-makers to observe other facets of preparedness, such as interagency communications and equipment availability.

Under the overall direction of the Operations Division, the EMS In Service Training Section was tasked with organizing this first large-scale disaster drill. This was a monumental task, requiring a realistic timeline for development, assignment of an appropriate number of personnel and a willingness to dedicate massive resources.

Discussions between department policy-makers and trainers about conducting large-scale drills began in July 2002. It was quickly determined that this type of exercise should be part of the department's overall disaster preparedness efforts, and work began immediately for the November drill.

Although four months sounds like a good timeline, there were a lot of things that had to be accomplished. For example, the department needed to create a scenario based on a set of objectives that addressed both its needs and those of the community. The overall goal for this effort was “to create a disaster training exercise that emphasizes a safe and organized approach to handling a potentially overwhelming situation, which forces rescuers from multiple agencies to work together to address medical, rescue and fire hazards.”

With an overall goal and a set of objectives in place, it became possible to work with the department's Special Operations Section to create several threat-based scenarios. Although no specific threat existed for any of the ones developed, intelligence from the FBI was used to identify venues and types of possible events. These included attacks on a high-rise building, a stadium, and a ferry or other mass transit.

Fortuitously, during this stage of planning the San Francisco 49ers approached the fire department with a request to conduct a disaster exercise at Candlestick Park, a professional football stadium with a seating capacity of about 70,000. We quickly decided that this venue was very well-suited to the goal of the exercise. The scenario of a small plane striking the stands during a game developed quickly from ensuing discussions.

A simulated plane crash

On November 2, a total of 650 volunteers were assembled, including students from several local colleges and universities, the Burlingame High School football team, the 49ers Gold Rush Girls and members of the community at large. Of these, 50 were considered fatalities, 200 were moulaged with varying degrees of injury and the remaining 400 played the role of a large crowd requiring evacuation. A local airport donated a single-engine airplane, which was partially dismantled with parts strewn in the immediate area. Smoke generators in the cockpit and the stands simulated fire.

The exercise began on schedule at 0950 hours when the scoreboard, which had been playing highlights from previous 49ers games, flashed with a loud and bright explosion. The stadium's staff immediately implemented the evacuation plan and displayed public safety messages asking the public to move toward the exits in an orderly fashion. Stadium security worked with the San Francisco Police Department to evacuate more than 400 spectators, many of whom had been given role-playing cards instructing them to exhibit less-than-optimal behavior. This aspect of the exercise was completed in minutes.

The fire department assembled 44 units for the exercise, staging them along the access road on the east side of the parking lots. They were placed in order based on unit type and alarm assignment. The pre-event staging area was placed under Section Chief Phil Harvey, identified as staging commander.

The first arriving unit, Engine 17, reported a “plane into the lower east stands of Candlestick Park” and initiated extinguishment and exposure protection. The crew stretched handlines to the east stands, called for a mass-casualty response and struck a second alarm.

Engines 42 and 44, Trucks 17 and 9, Medic Units 17 and 36, Rescue 2, and Battalions 6 and 10 responded to the Parking Lot C entrance of the stadium as the remainder of the first alarm assignment and began to set up for a long-duration event. Bttn. Chief William Serafini, responding as Battalion 10, established stadium command, locating the command post outside of the stadium and an appropriate distance away from the event.

The second alarm included Engines 8, 21, 43 and 32; Truck 13; Division 3; and Rescue Captain 3. The third alarm included Engines 10, 31 (responding with the department's Mass-Casualty Unit) and 20; Truck 10; Medics 43, 7, 8, 41 and 91; Rescue Captain 4; and Battalion 3. Additional ambulances were requested from King American Ambulance and American Medical Response.

On-scene response

Overall fire suppression efforts included hose lines to the fuselage on the field and the lower east stands using hydrants located on the stadium grounds. While San Francisco Bay is only a few yards from the stadium access road, incident command didn't deem it necessary to initiate drafting operations, as domestic water proved sufficient.

Capt. John Cavanaugh filled the role of medical group supervisor, who established the triage, treatment and transport areas outside of the stadium based on the notion that victims should be moved away from an area of potential secondary attack. EMTS and paramedics from the San Francisco Fire Department, King American Ambulance Service, American Medical Response and the Daly City Fire Department staffed these areas. Transportation for the hundreds of victims moved from the scene during the exercise was provided by 15 ambulances, four public transit buses and five helicopters.

The San Francisco Police Department responded with a total of 60 officers from the stadium detail, Bayview District Station and the SOS Bureau. The police command post was established in a predetermined location, and included fire department Battalion Chief Gary Leal, who served as liaison.

After establishing stadium command, Battalion 10's Serafini was assigned to air operations when Div. Chief Art Kiney took over as incident commander. Kiney oversaw the activities of five helicopters, including the East Bay Regional Parks Police, the California Highway Patrol, Calstar, Stanford Lifeflite and REACH Air Ambulance.

A landing zone was established in the Eastern Parking Lot, with security provided by the California Highway Patrol and the local police. Capt. Kevin Boone, a flight medic, and Sgt. Dan Linehan, a pilot, provided technical support and overall supervision for this portion of the exercise.

Volunteers add realism

A relevant component of any training, realism was viewed as an essential part of this exercise. The department used props and volunteers that allowed responders to suppress actual fires and treat realistic-looking wounds. The greatest and most time-consuming of the department's attempts at realism was the logistics involved in recruiting, transporting, moulaging, orienting and caring for a large number of volunteers.

Ensuring the safety and comfort of the volunteers was a major concern for the development team and must be addressed in any exercise that involves community members. On the day of the event, a logistics team of 30 San Francisco Fire Department staff, supported by Candlestick Park security and members of the University of San Francisco's theatre department, had to work quickly to move volunteers through check-in, moulage, orientation and into position in less than two hours.

To teach lay people to act as injured victims, the department provided them with laminated cards that listed responses to START triage questions. Paramedics on the logistics team also conducted a quick orientation, and the San Francisco 49ers provided breakfast and lunch for all of the participants, a monumental task unto itself.

Once the scenario began, the logistics team acted as safety monitors, with standby paramedic teams positioned to handle any real medical emergencies — an absolute necessity during any training. In an exercise that had more than 200 responders handling 650 victims in a highly charged scenario, the only reported injury turned out to be a case of severe overacting. Logistically, this exercise was an overwhelming success.

Multi-agency lessons

This drill was also viewed as an opportunity for the department to test its ability to work with multiple outside agencies, especially the San Francisco Police Department.

Department policy-makers and training staff created an exhaustive list of agencies from the city and county of San Francisco and surrounding communities that were viewed as essential elements in handling this scenario. Representatives from participating agencies were invited to regular planning meetings to offer input during the development of the exercise.

These sessions themselves became a great source of information and guidance for the fire department in handling mutual aid, air operations and interagency communications. Many of these agencies have expressed their thanks at being included in this drill, which underscores the need to be inclusive when planning such an exercise.

Without an honest assessment of the drill, all of the potential opportunities for future training and improvement would have been lost. To ensure a diverse set of observations, outside evaluators were recruited for a post-incident analysis.

The evaluation team was led by the department's assistant medical director, Dr. Michael Casner, and included members of the California National Guard's 95th Civil Support Team and the San Francisco Department of Public Health EMS Section. Each evaluator was assigned a different aspect of the department's response to observe. The San Francisco Police Department and Candlestick Park staff conducted evaluations of the law enforcement and evacuation portions of the exercise.

One week after the drill, evaluators and agency representatives met to share their observations. Based on these evaluations, the department learned that there was a need for a more effective joint command post. One of the positive outcomes of the exercise was the adoption of a new dispatch protocol for the San Francisco Police Department's Mobile Command Center. The unit will now be dispatched to all major fire department events, including greater alarms, at an incipient stage. This will provide an excellent platform from which to operate and staff the joint command post.

Overall, the response was seen as highly successful. Responders from three fire departments, three police departments, four EMS providers and five helicopter agencies worked together for two hours to extract, triage, treat and transport victims while engaging in fire suppression and handling a huge crowd that had been coached to behave erratically.

The drill showed the benefit of a unified command system and the need to further enhance the use of it. Furthermore, it provided insight into the amount of EMS equipment and transporting units that would be needed for a disaster of this magnitude. Evaluators' observations underscored the success of many aspects of the department's intensive disaster training efforts while providing suggestions for future sessions as well.

The San Francisco Fire Department will continue to hone its ability to handle any type of disaster through a program of ongoing training and testing. Future large-scale drills will be conducted following department-wide training sessions and will focus on other venues, battalions and shifts in an effort to ensure that every member of the department has an opportunity to experience a realistic disaster scenario.

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A 29-year fire service veteran, Mario H. Treviño has been the chief of the San Francisco Fire Department since August 2001. After serving 24 years with the Seattle Fire Department, he became chief of Las Vegas Fire & Rescue in 1996. Treviño has a bachelor's degree in public administration and was awarded a Harvard University Fellowship for senior public officials in 1998.

Niels Tangherlini, NREMT-P, is a paramedic captain with the San Francisco Fire Department. He currently works in the EMS In Service Training Section, where he provides continuing education to the department's 2,200 EMTS and paramedics.