The First Five Minutes: Rethinking ICS & MCI Response in Rural America
Illustration of crashed mini van
Prologue: Right Place, Wrong Time
“As I was driving home from an out-of-state work engagement, an eerie nightfall settled over a rural stretch of highway in North Carolina. What unfolded in the next few moments created a lasting impression that would alter my understanding of the Incident Command System (ICS) in rural America.”
At approximately 00:30 (per CAD notes), an automatic crash notification was triggered. While these notifications are often false alarms, this one was different. Dispatch audio later revealed nearly seven continuous minutes of children screaming—with no verbal response from the driver. Faint moans, possibly from an adult, were barely audible. Despite this evidence of severity, the response remained minimal.
The first due fire department—located only a couple miles away—responded with just two personnel. The first-arriving engine, understaffed and overwhelmed, called out over the radio: 'two vehicles off the roadway, heavy damage.' A short time later, scene command was declared by the captain. The official tone was maintained, but the scene quickly unraveled.
Caller #1, who had driven through the debris field, reported that one of the vehicles—a silver minivan—was smoking. It would later be confirmed that this minivan contained five occupants: an unresponsive adult and four young, unrestrained children.
Per CAD timestamps, the engine arrived on scene at 00:38. From that moment, it was clear that the incident was spiraling beyond control. No Mass Casualty Incident (MCI) declaration was made. No mutual aid was requested from neighboring departments. The two firefighters on scene were responsible for command, triage, extrication, and all medical interventions—a nearly impossible task.
I arrived approximately one minute after the engine declared 'on scene.' I had no intention of engaging until a distressed bystander approached my vehicle and said, 'There are only two of them, and they look like they’re having trouble.' I knew what that meant.
After identifying the officer, I introduced myself and asked how I could assist. He silently handed me a set of irons. Overwhelmed and likely in task saturation, the captain was not monitoring his firefighter’s actions or providing strategic oversight.
I conducted a 360 assessment of the minivan and observed all four children, unrestrained and in various states of distress. One was thrown onto the dashboard. Another lay across a collapsed seat. The driver was semiconscious, her eyes locked with mine.
The lone firefighter attempting extrication was locked into task fixation. Despite my attempts to redirect him to a more viable approach point, he became combative and resumed ineffective efforts at the same spot. I then identified a natural purchase point on the A-post, which I relayed to the officer.
Still, no EMS had arrived. No rescue units. And no mutual aid. Time was slipping through our fingers.
Eventually, a rescue unit was dispatched—not to assist with extrication, but to establish a landing zone (LZ). This decision, given the conditions, remains perplexing. Even after partial extrication, no request was made for mutual aid from closer, neighboring fire departments. Why? That question lingers.
This was more than a chaotic incident. It was an operational breakdown. And for me, it became a defining moment—the spark to reassess, rethink, and rewrite what rural response must look like.
The First Five Minutes Matter
In every emergency, the first five minutes lay the groundwork for everything that follows. In rural America, those minutes are magnified, defined by distance, limited resources, and the improvisation of those who arrive first. This article was born from such a moment. One where I, unexpectedly, became a witness to a chaotic yet defining multi-casualty incident. I wasn’t there to respond. I was passing by, yet the scene revealed lessons too important to ignore.
“It has been widely reported that the first five minutes determines how the next five hours will be spent on the fireground”
2. The Rural Reality
Unlike urban counterparts, rural EMS and fire agencies often operate with skeleton crews, limited equipment, and prolonged response times. Mutual aid is not guaranteed to arrive quickly, and the nearest hospital could be 30 minutes or more away. Despite these realities, expectations remain the same, stabilize, triage, and transport. This mismatch between expectation and capability can become lethal when the incident is high acuity, like the one witnessed here.
3. Anatomy of a Breakdown
The call began with an OnStar alert: multiple children screaming, no adult contact, and vehicle damage reported. CAD notes confirmed multiple units dispatched, but response was slow and fragmented. On arrival, only two firefighters were actively working the scene. No MCI declaration was made, no formal triage established, and extrication was delayed. These weren’t failures of individuals, they were breakdowns in a strained system designed for a different environment. This article seeks to identify and address those gaps.
4. The Myth of the Iron Fist
We are all too familiar with the 'Paragod', a paramedic archetype steeped in authoritarian control, intellectual arrogance, and a refusal to collaborate. This individual often equates title with value, rejecting ideas not born of their own mind. They mistake dominance for leadership, creating a culture where growth is stifled and safety is compromised. This is not to dismiss the necessity of rank or hierarchy, which are essential in emergency services. But there exists a leadership crisis, fueled by mass departures of experienced providers, that promotes unprepared or unqualified individuals into command roles. True leadership is qualitative, often carried by those without formal rank but with earned wisdom and humility. This is highlighted Why do so many Incompetent Men Become leaders, section 4, “The Myth of the Iron Fist”, to explain ego driven leadership.
““Egotistical leaders tend to reject feedback, suppress dissent, and promote yes-men, undermining collaboration and long-term effectiveness.”
5. Why ICS Doesn’t Fit in the Woods
Traditional ICS models, designed for scalable urban systems, falter in the rural environment. Small teams cannot fill Command, Triage, Treatment, Safety, and Transport Officer roles simultaneously. Command may be forced to operate while mobile, contrary to doctrine but necessary in practice. Urban systems presume redundancy; rural ones often have none. Insert Footnotes 4 and 5.
6. The Training That’s Missing
Drawing from personal experience, describe a rural department that overcame limitations through culture. Internal shift drills, mentorship, and a multidisciplinary exchange of ideas created operational strength far beyond the minimum training standard. They trained each other, medics to firefighters, officers to rookies—and developed adaptable tactics based on evolving roles and realistic scenarios.
7. Planning Prevents Poor Performance
This section highlights how the failure to pre-train manifests in scene dysfunction. Leaders must be made, not appointed. The absence of seasoned mentorship accelerates leadership failure. Planning must go beyond task completion and include cultural readiness.
“Detach. Step back. Observe. Analyze. Then move. If you don’t do this, you will make decisions based on emotion, not logic.”
8. The Quiet Fixes That Can Save Lives
Offer targeted, realistic improvements: structured mutual aid triggers, field-adaptable triage models, dynamic command assignments, training for mobile IC, and integration protocols for credentialed bystanders. Footnotes 6 and 7 may apply here (NREMT Scope & IAED Protocol).
“In rural settings, EMTs and EMRs are often the first and only medical providers on scene. Systems must ensure they are trained and authorized to perform time-sensitive interventions.”
Basic Strategy & Tactics requires more than planning and executing but it also demands anticipation. We must be able to think ahead of the present and make decisions
EXAMPLE:
You are stationed in the rural setting, 30 minutes from any major urban areas. You are the most senior first responder on duty that day with only a rookie firefighter accompanying you. It is the midnight hours of 0015 and you are toned out for a MVC, with one vehicle upside down,located down as steep embankment approx in a 15 foot down. There are multiple patients, unknown in severity, and the other vehicle is smoking. What resources do you suspect might be needed? Do you currently have the ability to activate them or require an official officer to do so?
While we are hastily moving to the apparatus, donning on gear, we should already be in the mind set of anticipating. This is a skill that you might not think requires a combination of gut instinct (derived from experience and intuition), accompanied by reading more into the situation. This is something we are all familiar with in the MEDEVAC setting. Our team would do this enroute to every activation. We would play out the worst case scenario and what moves we would take accordingly. This way, if we were met with the fate of that scenario, we had an idea how we would act individually but as a team.
“Long Tern thinking is about nurturing a legacy mindset, being a good ancestor. It means looking the now”
9. Small Teams, Big Cracks
(Tactical & Team Performance Analysis)
It’s no surprise that small team dynamics are at the core of many rural and volunteer departments. But let’s be clear, having a small crew doesn’t automatically mean poor scene management or a doomed response. What truly matters is how well a team functions together, how cross-trained they are, and how capable they are of adapting to the needs of the incident. Numbers matter, but quality matters more.
In fact, when every team member is trained and empowered to shift roles based on real-time demands, you create a force multiplier effect. A three-person team trained to think, communicate, and operate like five can level the playing field in a way that raw manpower can’t.
We see this concept used in elite, small-unit teams like Navy SEALs, Army Rangers, and Recon Marines. In public safety, we also see it in light technical rescue teams or hazmat groups. You may be thinking: “But I’m not a SEAL or a hazmat tech,”, and that’s fair. But the point isn’t about being the same; it’s about adopting what makes them work.
What these teams all have in common is this: they train, relentlessly. They rehearse known threats, simulate unknown ones, and work through evolving variables. As Jocko Willink says, “When you train hard, you fight easy. The more you sweat in training, the less you bleed in battle.”¹
So why don’t we treat rural response any differently?
In many ways, the rural responder is already a specialist. You operate in austere environments, often without backup. You’re required to show up with the same expectations but far fewer tools. That makes you different, and it should make your training different too.
Rural providers must be ready to think like officers, even if they don’t wear the bugles or hold the title. If you’re the first to arrive, you may be the only one there for several minutes. That means you must start processing the scene, initiating command, and preparing for escalation, regardless of your badge or years of service. Waiting to be told what to do is a luxury you don’t have.
Versatility is survival.
When you’re adaptable, when you’re fluid, you give yourself and your team a better shot during those first few critical moments. The mission starts with your first view of the scene. If you can get your eyes on what’s happening, paint a picture quickly, and communicate clearly, you’ve already started the response on the right foot.
Pre-incident training matters. But so does a good scene size-up.
In rural response, units are likely coming from across the county, or beyond. Getting that size-up right can determine whether you receive the help you actually need. And once additional personnel arrive, that’s when you start building out the traditional command structure, piece by piece.
This is a stark contrast to most urban departments, where officers, senior personnel, and full crews tend to arrive in waves within minutes of each other. Urban scenes still carry the potential for chaos, but they benefit from built-in depth and structure. For rural providers, structure must be built on the fly.
Small team dynamics don’t mean failure. They mean you need to think differently, and sometimes unconventionally. Algorithms, protocols, and SOGs absolutely have their place. But in the grey space, where guidelines don’t quite fit, you have to be willing to interpret, adapt, and act. That’s how rural teams win the day.
10. The Scene That Changed Everything
Close with a reflective summary. This was more than an incident,it was a turning point. Use emotional language grounded in humility and purpose: 'I didn’t respond to this call, but it called something into action in me.
Have comments, questions, or suggestions? Let’s Continue to conversations?
