Podcast Summary: Becker’s Healthcare Podcast

Episode: Beyond Checklists: Readiness vs. Reality, Leading MCI Change

Guests: Ben Toombs (Director of Emergency Programs, UW Health) & Nicholas Bell (Manager of Safety and Emergency Management, UW Health)
Host: Scott King
Date: February 21, 2026

Episode Overview

In this insightful conversation, Scott King sits down with Ben Toombs and Nicholas Bell from UW Health to examine the realities—versus the checklists—of Mass Casualty Incident (MCI) preparedness. The discussion explores the misconceptions around MCI readiness, evolving threats, the balance between protocols and practiced habits, mental health for staff, inter-organizational coordination, and strategies to avoid “checkbox” emergency planning.

Key Discussion Points and Insights

1. The Biggest Misconceptions About MCI Readiness

• False Sense of Security from Planning
  Ben Toombs cautions that simply having an MCI plan or an annual drill can lead to dangerous complacency:

  "You have this false sense of security where you say, well, we've got this binder, we have these policies and we have this annual drill. So therefore we're ready for an MCI. But actually, most failures...isn't on the clinical side. It's actually looking at the organizational logistics side of how to deal with an MCI." (03:02)

• Operational Muscle Memory
  Ben explains the necessity of frequent, realistic exercises:

  "The reality of an MCI and how to handle it, it's like an operational muscle. You have to constantly be using it and testing it to really make it stronger and more robust." (03:32)

• Knowing Your Limits and Real Needs
  Honest assessment of logistical limits and supply chain vulnerabilities is key:

  "Organizations need to be really honest with themselves about what their logistical challenges are and what their supply chains are and how that is going to interact with their MCI plan." (04:25)

Memorable Moment

• The "what does that mean?" exercise helps dig beneath assumptions, e.g.:

  "So when we talk about our MCI planning, we always say, well, what does that mean? And we really dig deep into that conversation..." (03:54)

2. Evolving MCI Threats and What Has (Not) Changed

• Broader Hazard Lens Over Time
  Nick Bell outlines shifts from terrorism and bioterrorism post-9/11, to all-hazards preparedness post-Katrina, to infectious disease after COVID-19, and most recently, cybersecurity threats:

  "Maybe one of the newer things that we think about more today...is cybersecurity...the possibility of a cyber attack..that could have some really significant impacts that leads to a patient surge event." (08:47)

• Mental Health Focus
  Addressing responder well-being is now vital:

  "A positive...today is that there's been an increased focus on staff mental health and well being and recognizing that these situations can be traumatic..." (07:13)

• Active Shooter Events Dominate Concerns
  Modern planning now centers around large-scale shootings and rapid overwhelm:

  "When you discuss this topic with people today, the one that has them worried...is a large scale active shooter incident..." (09:41)

• Continuous Improvement Following Real Events
  The 2024 school shooting at Abundant Life Christian in Wisconsin was a turning point for UW Health's approach, spurring:

  • Creation of an MCI preparedness steering committee
  • Open, no-fault reviews
  • Revamped plans across surge response, labor pools, traffic control, and family reunification (10:31)

3. Supporting Staff Well-Being During and After MCIs (11:00)

• Resource Activation via Incident Command
  Nick explains their approach:

  "We have an employee assistance program...we can link our employees to to make sure that they get that mental health support that they need...activated through our hospital incident command system." (11:22)

4. Protocols vs. Patterns Under Stress

• Habits Over Policies
  Ben stresses ingraining patterns through repeated training:

  "When you're in a stressful situation, you tend to go back to that safe, known pattern...people revert back to habits, not policies, in some respects." (12:29)

• Job Action Sheets and Role Clarity
  Assigning clear roles helps maintain operational control and safety:

  "...nudging habits down into the right pathway. So when those stressful episodes do happen, those patterns are already ingrained into what needs to be done." (12:49)

• Making the Unknown, Safe
  Role clarity reduces the psychological burden for providers:

  "...giving people those roles...making a unsafe, unknown environment to a safe, unknown environment." (13:34)

5. Common Points of Failure: Where Does MCI Planning Break Down?

• Governance and Communication
  Nick identifies the bottlenecks:

  "Governance and communication fail before execution can really even begin. So, you know, execution is downstream from those things." (14:35)

• Decision-Making Authority
  Clear delegation and empowerment are crucial:

  "Who has the authority to make decisions during an incident?...Having them feel empowered...is super important for everything else after that to work." (15:29)

• Communication Flow
  Timely, escalating, and flexible communication beats one-size-fits-all:

  "You need to build mechanisms in your communications plan to quickly send timely updates out to everyone...an escalating communication flow that had a number of concentric circles." (17:06, 18:06)

6. Integration Across Systems and Partners

• Within Health Systems
  Activation protocols may cover multiple hospitals, but flexible by building due to circumstances.

• Regional Integration
  Collaboration and common operating language with EMS, public health, and area hospitals is non-negotiable:

  "If you have a local, ideally multi agency, multi organizational emergency preparedness committee...you should be involved in that." (19:28)

  • Base Hospital/Medical Coordination Model
    Example from Dane County:

    "When an MCI occurs in our community, responding EMS...request activation of base hospital...they send out an alert to all the area hospitals requesting information on capacity..." (20:43-21:21)

    • Ensures efficient, rational distribution of patients
    • Flattens surge, preserves system wide capacity

7. Keeping Preparedness from Being a “Checkbox” Exercise

• Continuous Scrutiny and Honesty
  Ben advocates asking “what does that mean?” for every policy, even the mundane:

  "You really need to go into minutiae and really look at every single aspect and say, okay, our policy says this, well, who's actually going to be doing that role..." (23:12)

• Embrace Discomfort in Drills
  Growth comes from rigorously testing assumptions and encouraging questioning:

  "If we're making everybody feel uncomfortable during a drill, we're doing it right. Because that uncomfortable feeling is you questioning and you taking part of that continuous improvement culture..." (24:09)

• The “But” Principle
  An honest culture admits what still needs work:

  "It went well, but we could have done this, this, this, and this. Because there's always something that could be learned from anything, and that's something that we want everyone to walk away with, is ask yourselves, what does that mean?" (24:43)

Notable Quotes & Memorable Moments (w/ Timestamps)

• Ben Toombs:

  "Most failures when it comes to an MCI isn't on the clinical side. It's actually looking at the organizational logistics side..." (03:07)

• Nick Bell:

  "...today...there's been an increased focus on staff mental health and well being and recognizing that these situations can be traumatic and staff need to receive the support that they need as part of our crisis response." (07:13)

• Ben Toombs:

  "People revert back to habits, not policies, in some respects." (12:31)
  "If we're making everybody feel uncomfortable during a drill, we're doing it right." (24:09)

• Nick Bell:

  "Governance and communication fail before execution can really even begin." (14:35)
  "You need to build mechanisms in your communications plan to quickly send timely updates out to everyone." (17:06)

Timestamps for Key Segments

• [01:26] The biggest misconception about MCI readiness
• [03:54] The "what does that mean?" exercise
• [06:27] What’s changed and hasn’t in MCI planning (Nick Bell)
• [09:41] Active shooter events and modern MCI concerns
• [10:31] UW Health’s real-world MCI (2024) and continuous improvement
• [11:20] Staff mental health in MCI contexts
• [12:09] Protocols vs. habits in high-stress clinical environments
• [14:29] Where MCI plans break down: governance & communication
• [18:55] Integrating plans across systems and partners
• [22:41] Preventing checkbox MCI planning; promoting continuous improvement

Closing Thoughts

This episode provides a transparent, practical, and forward-thinking look at MCI preparedness. It underscores the necessity of relentless realism, cross-disciplinary collaboration, and ongoing evaluation—always asking “what does that mean?”—to ensure systems are ready for the unpredictable. Ben and Nick’s perspectives demonstrate the importance of both humility and rigor in protecting patients, staff, and communities.

For more on MCI preparedness, operational leadership, and healthcare crisis response, visit Becker’s Healthcare Podcast.