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Exercise Northstar V – A Personal Perspective

Exercise Northstar V, held on 8 Jan 2006, was a multi-agency ground exercise aimed at testing our capability to mitigate a multiple incident site terrorist-related bombing -- via both conventional and unconventional means -- of a civilian target. This highly publicized event also served to increase public awareness of the aftermath of a terrorist attack in Singapore

If this was Northstar V, then what constituted I to IV?. This series of Northstar exercises started in the 90’s as part of civil preparedness against an industrial HAZMAT incident.  The forerunner was a massive ground exercise conducted to gauge the response of SCDF and its supporting agencies (SPF, MOH, NEA etc) to the unintentional release of an industrial agent from Jurong Island.  However, our concern with a HAZMAT release in Singapore was heightened by another historical event in March 1995, when a domestic Japanese doomsday cult intentionally released sarin (a nerve agent) into the Tokyo subway system, killing 12 and injuring more than 5,000.  This event highlighted the vulnerability of the “innocent public” to a change in the operational mindset of terrorists.  In addition, the flood of self-referring, walking casualties and worried-well victims rendered the emergency departments in the receiving hospitals a contaminated area.  A quarter of the clinical staff on duty that day were affected by secondary contamination from arriving victims who were not decontaminated prior to medical treatment due to various reasons.

What’s the verdict of Exercise Northstar V? 

What are the hits and misses?

The Hits:

1.   The exercise allowed the command, control, and co-ordination of multi- agency ground forces spread over multiple incident sites. 

2.   The public was involved in the exercise both at the incident ( as evacuees ) and peripheral sites.

3.   Political and Civil Service leadership saw for themselves the consequences and response required to mitigate such a massive and destructive event.

Hospitals got to set up, demonstrate and validate the operating procedures of their decontamination stations

The Misses:

1.   The “warm start” to the exercise did not allow crucial parts of the response system -- such as activation and assessment of the situation by disaster managers -- to be played out. 

2.   The anticipated or set-play nature of the event did not allow for natural interaction between response forces.

3.   The short duration of the exercise did not bring out the many situations and issues (some of which may be more important than the acute impact phase) that predominate in the post-impact and recovery phases.

From a personal viewpoint, the major challenges to the health services do not lie in our ability to triage, treat or transport casualties from the incident site to hospitals, or the ability of our hospitals and alternate care facilities to manage conventional and unconventional injuries.  The real challenges lie in our ability to assess the situation based on the relative lack of reliable information at the outset, our prudent use of healthcare resources, and the various management strategies available in coping with the initial chaos and overwhelming numbers through well-rehearsed plans.  As emergency physicians, we pride ourselves in our ability to sort out undifferentiated patients presenting at all hours and at different levels of acuity under less than ideal conditions.  However, these skills may not be enough to tackle a truly staggering human catastrophe.  A change to our normal mode of operation and acceptance of an altered standard of care are just some major paradigm shifts and mindset changes required.  Unfortunately, these were not part of this exercise. 

Are we prepared?  You be the judge.

 Dr Mark Leong

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The Society for Emergency Medicine in Singapore c/o Department of Emergency Medicine

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