Mass Casualty Incident Training: Inside a Multi-Agency MCI Drill

Mass casualty incident training doesn't begin when the scenario starts. For Royal Ambulance crews who recently participated in a large-scale MCI drill alongside military personnel, state EMS agencies, and public safety partners, the preparation started long before anyone arrived on site.

The first thing I noticed was how quickly everyone got to work.

There was no dramatic briefing. No long explanation of what was about to happen. No time spent standing around waiting for instructions.

As crews arrived, they were immediately directed to staging areas, assigned responsibilities, and integrated into a response that was already beginning to take shape. Information was limited. Details changed throughout the day. The only thing that was clear was that everyone had a job to do.

What the MCI Drill Involved

As the scenario unfolded, participants learned they were responding to a simulated mass casualty incident involving patients arriving by military aircraft and requiring transport to hospitals throughout the region.

For Royal Ambulance crews, the challenge wasn't simply transporting patients. It was learning to operate within a much larger system involving EMS agencies, hospitals, military personnel, and public safety partners — all working toward the same objective.

What Stood Out Wasn't the Scale, It Was the People

While the exercise itself was impressive, what stood out most wasn't the aircraft, the scale of the operation, or even the complexity of the scenario.

It was the people.

Throughout the day, Royal crews moved from assignment to assignment with confidence and professionalism. They communicated clearly, adapted to changing information, and worked seamlessly alongside agencies they don't interact with on a daily basis.

Watching them operate, it became clear that the teamwork on display wasn't built during the exercise.

It had been built long before anyone arrived.

It was built during routine interfacility transports. During long shifts. During everyday patient encounters. During the countless moments that rarely make headlines but quietly shape providers into effective teammates.

Why Trust Is the Foundation of Mass Casualty Response

Large-scale MCI exercises often focus on testing systems, protocols, and communication plans. They should.

But they also reveal something else: the value of trust.

When information changes, trust matters. When multiple agencies are working together, trust matters. When patients need to be moved quickly and safely, trust matters.

The crews participating in this multi-agency drill relied on the same skills they use every day: communication, adaptability, professionalism, and teamwork. The environment was different. The expectations were higher. But the foundation remained the same.

What EMTs Took Away from the Drill

For EMT Wayne Marmon, the experience highlighted the value of working alongside partners outside of Royal Ambulance.

"It was truly inspiring to collaborate with the military," he said. "Their precision and dedication amplified our impact."

Others left with a greater appreciation for the complexity of managing a large-scale mass casualty response.

"Seeing so many moving pieces while being involved in this experience gave me a greater appreciation for the adaptability and collaboration required to effectively manage an MCI," said EMT Tatiana Barquero.

For EMT Lauren Hinrichs, the exercise reinforced the importance of cross-agency teamwork.

"It was eye-opening to witness live actors respond to our triage interventions and collaborate with state EMS and military teams during this large-scale simulation," she said.

Preparedness Is Built Every Day

The scenario itself was fictional. The lessons were not.

Mass casualty incidents are rare, but preparedness requires more than hoping they never happen. It requires EMS agencies to train together, communicate together, and learn from one another before an emergency ever occurs.

Multi-agency MCI exercises provide an opportunity to do exactly that.

For Royal Ambulance, they are also a reminder that readiness isn't built in a single day.

It's built every day.

One shift, one patient, and one team at a time.

Learn more about how Royal Ambulance serves the Bay Area, from everyday interfacility transport to large-scale emergency preparedness. Explore our work.