On November 14th Uwchlan EMTs experienced how chaotic and overwhelming a mass casualty incident can feel. A training event held by the Ambulance Core introduced personnel to a mass casualty incident consisting of a simulated bleacher collapse in the gymnasium at Downingtown East high school. There were approximately 15 victims presenting with a large range of injuries.
EMTs were dispatched to a single injured person from a fall. Upon arrival, the level of noise from screaming that could be heard outside the building was immediately a clue that multiple people were involved. A mass casualty was declared and the crew responded appropriately. The mass casualty gear bag including triage tags, identifying vests, tarps, and the incident command table was brought in from the truck along with protective gear. An incident command leader was established, a triage leader was established and triage began. Utilizing the cards attached to the priority tags, initial triage could be completed in minutes. A treatment team leader was established who made sure there were designated areas to treat each priority level and appropriate people in each area to care for the patients.
After initial triage, it was time to move the patients. The walking wounded (priority threes) had already been told to get up and walk away from the collapsed bleacher to the treatment area. Priority one patients were moved first unless someone else was in the way to get to them. To make the incident more realistic EMTs were given a limited amount of supplies to work with. Plenty of backboards were around however; there were no straps to secure the patients. The ingenuity of EMTs showed using tape, gauze, and cravats to secure patients. No head blocks were available either and as such EMTs utilized clothes, trauma dressings, gauze and tape to stabilize the patients' heads. The need to be resourceful on a mass casualty scene was stressed not just with supplies, but also with people. Each patient on a backboard required four people to move them. Police officers, by-standers, and fire fighters all were utilized to help transfer patients to the correct treatment area. While moving and treatment is occurring, the transport leader must start designating people to ambulances with appropriate care levels. Firefighters could be used to drive ambulances in order to allow more EMTs to be free to treat patients. Police officers were also used to control disruptive patients.
Most problems that could occur in a real mass casualty incident occurred in the training. Each priority level presented different obstacles for the crews on scene. The priority ones presented trauma and medical problems that required immediate transport. A few priority twos had underlying problems that if not identified within minutes would have caused death. The priority threes decided that it would be fun to be unruly and confrontational with the crews. There were radio communication failures, bad weather, no helicopters, no additional ambulances or personnel, hysterical patients, lack of supplies, a pregnant woman giving birth, a wheelchair bound patient, and even a hidden patient. To quote one EMT that was present at the training "I learned what to do in the classes, but now after doing it I feel prepared. I know that though I want to run in and save everyone I have to take a step back and follow the command system because it works."
A big thank you to all who helped put this training event together and all that came to give advice and help out. It was a great experience.
