Tsunami in Chianti – Military forces exercise fighting a humanitarian disaster
Every two years the beautiful group of the Hawaiian islands are venue for one of the worlds largest Naval exercises. Participants for the countries around the Pacific Rim gather for the four week military exercise RIMPAC. This year Navy units from 22 nations participated with about 25.000 soldiers, 40 ships, six submarines and 200 flight devices. While in the center of the Navy’s public work was the “Green Fleet”, having engines created, that they could be run by nutritional leftover fat from restaurants and nutrition industry, a further premiere made it much less into public work and awareness:
Besides multiple war and fighting scenarios sub- and marine and also on main land, this year for the first time the activities of the Navy in a humanitarian disaster situation was exercised. A quite small amount of about 1,500 soldiers acted on the assumption of the effects of a Magnitude 9.0 earthquake in Chile and the resulting Tsunami which hit the fictitious island state of “Chianti”. The Chianti map though was very similar to the main Hawaiian island Oahu. To get this situation under control and bring relief to the affected nation, together with the non-governmental organizations (NGOs) also the Navy was activated. A red and white cell was installed in a tent camp in Pearl Harbor to manage the relief efforts as well as the exercise.
As in a real event, the lead of the relief operations in general was taken by the affected government which set up a crisis staff called “Humanitarian Assistance Coordination Center“ (HACC) where all mobilizing relief organizations, NGOs (such as Red Cross, WHO, World Food Program) as well as UNO / UN OCHA were represented. These roles were played by experienced relief helpers from inside and outside the military from Australia, Canada and USA. Spontaneously the author was asked to fulfill the role of Red Cross first as representative of Chianti Red Cross, later the international Red Cross. The representatives of Chianti government were played by short contract employees of a California based agency, specialized in providing actors for military trainings and exercises. Also a representative of the Hawaiian Ministry of Health participated. To keep up with information shared, a liaison officer of the Navy also participated in every cluster meeting.
Contact person for the military forces at the HACC was the representative of USAID. All requests for help directed to military were to be forwarded to the USAID representative. After assessing the request and only when there is no NGO to fulfill the task, the military forces are tapped into action. So the main challenge for USAID-Delegate Liz Mantillo in the first three days was to make this clear to military leaders. The sentence “This request is to be directed to USAID.“ was being heard several times. “From the third day on it became much easier,“ Mantillo stated with relief. “From then on the responsible Navy staff had understood and accepted the role of USAID. Also the reporting in both directions approved from day to day.“ At times the injects of the military had to be corrected or even cancelled because they did not reflect the facts as they happen in reality. For example the planned request of Red Cross for armed support in a big shelter in the Aloha Stadium and to protect the Red Cross warehouses had to be taken out of the script, as Red Cross never engages armed forces to secure personnel, vehicles or facilities.
At times there had to be arranged a compromise as the Navy used the exercise also to test newly developed techniques such as an Android based device for assessing potential ground for a mass shelter or a field hospital. The device was created to help measure and calculate the area of the assessment site. Normally relief organizations do this assessment on their own. For the Navy being able to test their devices the agreement was arranged that the Navy assists the NGOs in the assessment with their devices. The sincerity of the military forces participating and their willingness to work together with NGO’s in the meetings and actions taken was remarkable.
Situation Awareness also via “Crowdmap“
A further tool that had to stand the test in this part of the exercise was “QuickNets“ – a further development of the Crowdmapping-application “Ushaihidi“. Catherine Graham, Vice President of the worldwide digital disaster network “Humanity Road“, which significantly helped in the practical testing of QuickNets, explains the further development relating to Ushahidi: “Ushahidi was developped in 2009 to monitor mistreatment and killing at the Kenya elections. So it is a pure and one dimensional situation tool. QuickNets further developed the application to be actionable and so better usable in disasters. The goal is to make it possible to get an overview not only about the requests for help or support on a map, but also make it possible for relief organizations to take over such requests and mark them as e.g. “in process” or “done”
With pride, Graham points out: “For this exercise, under the lead of Humanity Road 83 volunteers of 13 countries created more than 2.000 injects in a 7-day pre-exercise verified and geolocated them. This was quite a huge project and I am grateful for the enthusiastic engagement of our volunteers!”
The communication during the pre-exercise went via group chats in Skype. To some of the locations where the injected requests for help came from, real Navy forces were sent and the demanded relief efforts were taken, e.g. persons were located and rescued from under rubble and in the harbor Navy divers from New Zealand were assessing debris and potential damages.
The insights, gained during the exercise regarding QuickNets, were immediately taken care of and put to another test in the military exercise “Pacific Endeavour” in Singapore in August. As soon as the tool is ready for use, it will be available as an open source tool.
The common communication platform for all participants was offered by APAN (www.apan.org), an internet portal of the American Department of Defense (DoD). APAN is not a primarily military platform but, according to their own information “a web based collaboration platform that enables information sharing between the Department of Defense and partner nations, foreign militaries, international organizations, non-governmental organizations, inter-agencies and individuals that do not have ready access to traditional DOD systems and networks.”
For the first time APAN ( All Partners Access Network) helped support communication for the military forces who were involved in the operations after the severe earthquake in Haiti 2010 and also after the earthquake and Tsunami in Japan in 2011. APAN enables users to store, access and retrieve documents, situation reports, protocols, pictures etc. Also the possibility to chat or discuss topics in a forum. The APAN network is not only active in disasters. In several groups of interest discussions are also active in times where there is no disaster.
Final Disaster Exercise
While during the week about 500 persons were involved in the HA/DR exercise (HA/DR = Humanitarian Assistance / Disaster Response) on the last day an additional 1,000 participants were involved in a final disaster exercise on Hickam Airfield, Pearl Harbor.
This exercise involved also non-military forces, especially “Health Association of Hawaii“ (HAH) and their branch HAH Emergency Services were involved. “HAH is a charity network that connects more than 115 health care organizations in Hawaii,” Adria Estribou, HAH Manager of Communications, describes the task of the organization. “Hospitals, retirement facilities, social services, air and land rescue, blood banks and laboratories are supported and coordinated in crisis management and preparedness.” A Disaster Medical Assistance Team (DMAT) is provided on a voluntary basis. Some of those DMAT Teams collaborated in this exercise and set up an “Acute Care Module“ (ACM). This module consists of three tents for patient treatment and is able to treat about 50 patients per hour. All in all six ACM are provided on the four Hawaiian islands. Operability is to be installed latest four hours after being alerted.
As mentioned above, all DMAT staff are volunteers. In case of an alert and also for exercises they are treated like reservists which means they get a small salary and insurance. Although a medical profession is not necessarily required, most of the DMAT volunteers are nurses or paramedics. They are highly motivated. Many of the staff describe their motivation to engage in disaster relief similar to nurse Dwayne: “I love to take the opportunity of being able to work under conditions of a disaster for a change to my daily work, but also it means I can do something important for the people in my country.” In addition to monthly trainings and further education at least two exercises are required for each DMAT. At least one of these exercises must be a disaster exercise, involving also other disaster relief organizations.
As the ACM had been erected already on Thursday, the first “wounded persons” started to arrive at the site at about 6 am on early Friday morning. Most of the injured persons were acted by staff of the 23 Hawaiian hospitals that engaged in the exercise and later awaited injured persons to exercise their own emergency management. Four tents were erected only for the moulaging to make the injuries look like real ones. On prepared sheets, the basic wound elements were already prepared to be applied to the designated location of the injury and perfected to look real. From an abdominal impalement trauma through burn injuries to psychological trauma all kinds of injuries that could happen after a Tsunami were represented.
For the treatment of the patients another four tents were erected: The first one, built as a tunnel, for triage. The incoming patients are classified in three categories and transported or led to one of the three tents according to their injuries:
- Red = severe injuries, lying
- Yellow = light injuries, walking
- Green = no injuries, psychosocial support
Patients who die during their treatment are signed with a black label. In a fifth tent drugs and material is stored.
When arriving at the ACM, a patient gets a patient card at the triage tent, already individually numbered with a barcode. This barcode is immediately scanned with a special device called HPATS (= Hawaii Patient Assessment Tracking System). HPATS is a self-developed tool and with small restrictions it can also be run as an iPhone App. After addition of personal data via keyboard or a pen on the screen, a photo of the patient is taken. “This is an additional way to make sure the right patient gets the right treatment and no change with cards or even patients can occur,“ Barbara explains. Barbara is nurse and today responsible for the registration and triage of incoming patients. She doesn’t make a secret of the fact, that this exercise is also an important opportunity for a test of the soft- and hardware. So it is no wonder that a second person documents the patients manually on a paper sheet. “If all works well, the data of the patients can be entered by the hospital who is going to treat the patient. The broadcasting of the data runs via internet by an UMTS module, to which any of the devices are connected,” Barbara continues. “The advantage is that the hospitals can prepare for their patients and the way of the patients can be followed. Also numbers and statistics are at hand very quickly.” The EOC has also access to the data.
After being registered and triaged through an experienced staff (nurse or a paramedic) the patient is transported or led to the tent for further treatment according to the triage color. For triage “mSTART” is used. Most of the work is done by the nurses and paramedics; there is one doctor on site who is to be called for critical decisions. On this morning he is not really kept busy.
In the “red“ tent a patient with an abdominal impalement trauma is just being treated. The imaginative intubation is marked by a signed band-aid on the chin, also i.v. treatment. The patient next to her has two fractured legs. They are stabilized by cardboard splints that are attached together at the feet and fixed with band-aids along the legs – a quite effective solution regarding the medical and also the cost side.
The triage for transport is also done by an experienced member of the staff. Both of the above mentioned patients are chosen to be transported via helicopter for further treatment in hospital; How to install an improvised heliport was subject of a teaching and practical exercise for some of the staff the day before.
For taking patients from the ACM to the heliport the DMAT has an ATV. So both patients are now transported to the helicopters. Two Seahawk MH-60S are awaiting them. To not over exceed the means of transportation, the rest of the patients are transported by busses to the hospitals of their destination. “The participating hospitals could also place their wishes during the planning period,” Toby L. Clairmont, HAH Director Emergency Services explains. He is also mission leader on site. “One clinic e.g. wished that the patients by bus should arrive quite at the similar time as the helicopter patient. So we are trying to fulfill these wishes.” As around noon the end of the exercise is announced, he and his colleagues are slightly exhausted and quite satisfied. “The scenario and the collaboration with the Navy in this way was very helpful and we learned a lot.”
For the first time during the biennial military exercise RIMPAC an HA/DR-Component was implemented, as military forces can support humanitarian efforts and organizations in a disaster on a short term basis with technology, material and manpower. Two main topics to consider is on one hand the self-awareness of military forces as auxiliary to civil and non-governmental organizations, on the other hand communication with governmental instances, NGOs and also the public is vital. All participants agree that the next RIMPAC shall again have an HA/DR part that should implement even more factors. Along the running exercise there already were discussions about integrating psychosocial support through Navy Chaplains as well as improving communication with the affected population through traditional as well as social media.