Category Archives: Mass Casualty Incident

Special Call Mobile Surgery 1, Mobile Surgery 2, EMS Surgeon 1…

A nice resource to have if your system is innundated by, oh I don’t know, the shaking of the earth until everything falls down.  Especially in a City with water on 3 sides and only 4 trauma bays…total.

 

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Alert for the Haz Mat Incident

Our engine boss is cramming for the Captain’s exam when the bells ring for a call at the golf course.  A HazMat at the golf course.  This could be interesting…

THE EMERGENCY

Multiple calls for multiple sick persons, unknown cause.

 

THE ACTION

There are a few things we look for on the way to these types of calls, right?  There was no smoke, or cloud, and we approach from upwind, despite the requests from local law enforcement to pull up to the main entrance with him.  However, his skin remained intact and he was conscious, so our trusty litmus officer was helping in an odd way.

There were, however, 2 things that had me curious on our approach.  First, the ambulance had arrived before us and was staged across the street.  Second, there was a line of cars exiting the parking lot in a hurry.

Something was up.

 

We parked upwind at a hydrant so we could hook in and mass decon if needed.  Airpacks went on and the triage kit came out of the side compartment.  I was having trouble resetting my mind from being the EMS supervisor the day before, to being part of the engine company today.  Part of me wanted to establish the warm zone and set up the decon corridor while also designing ambulance ingress and egress.

Instead I had to find out what on earth spooked an entire golf course to run like hell on a beautiful California afternoon.

The remaining people near the clubhouse are pointing and giggling at the firemen approaching taking full precautions as we’re shouting for them to remain still and tell us wha on earth is going on.

As with most emergencies of this nature, their first action was to come towards us.  Great.

“In the kitchen,” a man with a name tag tells us, “Pepper spray.”

Huh?

Around the side of the building is a person with a wet towel on their face and a group of white shirt, checkered pants clad folks, clearly the kitchen staff.

Someone thought it would be funny to release some pepper spray into the kitchen during the lunch rush.

When the entire staff ran out of the kitchen screaming and rubbing heir eyes, the patrons thought the worst and did the exact wrong thing.

They dispersed themselves across the City and the region before we had identified what had happened.  Perhaps they understood it was pepper spray, but none of the non-kitchen staffers were able to tell us what had happened, so I doubt that.

Now imagine it was somehow something more sinister and all 300 people escaped without being decontaminated.  There you are in your district running a general sick call.  She mentions being in San Francisco a few hours ago on a golf weekend that went sour.  Then the husband vomits and passes out.

Worst case scenario sure, but we deal in those sometimes.

Any ideas on how to stop those evacuating?  And don’t say PD, because remember, he’s already in the hot zone.

Sunday Fun – New Triage Tag

We have all come to be familiar with the black, red, yellow and green triage tags and train repeatedly on thier application.  Whether it's a neumonic a 5th grader can follow or based on common sense assessment, we know the green are slightly injured and the black tagged folks are dead.  The red and yellow cover everything else from a respiratory rate of 31 to myself, with a natural cap refill of 3-5 seconds.

We are trained to assess, tag and go to the next person.

The system works great on table top scenarios, in drills and even in the field at mass casualty incidents, but I was inspired recently to introduce a new color/tag/classification to the triage kit.

I know, exactly what we need, right? Another confusing category.

 

Well, this one makes it even easier, believe it or not.

White.

White Flag by erix!I am officially adding WHITE to the triage category here at HMHQ.

When triaging you will no doubt come across persons with no injury, illness or complaint, but see the opportunity to become part of what they believe will be a chance to make a few bucks.  This is not uncommon in my area during bus incidents.  A bus will have a minor collision or hard stop and call for help.  Before help arrives, people will climb on the bus and create injuries inconsistent with the collision or direction of hard stop.

These people will fall into the NEW classification of WHITE or "I surrender."

When in a triage situation, if I encounter someone who is uninjured and ambulatory, they are not "walking wounded" but simply "walking."  Last I checked we can do very little for the "walking" other than sitting them down, tagging them green and wasting what few resources we have on them.

Same goes for persons displaced after a fire in their building or adjoining buildings.  They should be triaged WHITE and told to wait nearby for information from the Red Cross or other agency who can help them.  If there is no injury, a green tag seems wasteful, does it not?

Have you ever encountered an MCI with a crowd?  How do you know who is hurt and who is not?  By asking?  Great assessment skills there, Sparky.  Don't let your mind get lost in the sea of "Oh my God there's 10 of them!" and remember that you are doing triage based on your agency's instructions.  Chances are you're using the START Triage system, which assumes by the time you arrive and assess that life threats will be already changing mentation, respirations and perfusion.  Keep in mind that an ambulatory person missing an arm, breathing 22 times a minute with good cap refill on the remaining arm is a green under this system.

But let's get back to the lady wandering the triage area asking who to talk to about suing the building owner/bus company, or who states they were hit by debris but show no signs?  Are they GREEN or are they something less?

Currently the system does not let you make that determination.  After all, what do you know anyway.  Just tag them and deal with it later.  And by later, I mean let treatment sort it out, right?  While it does take a short amount of time to properly tag a person with name, age, allergies, medications, pulse, respiration and mentation status, we could be helping the next person who actually needs us.

Getting to them later is not a liability, spending time confirming they are uninjured is the liability.

So why does the system not account for the liability of the "walking?"

 

Because until now there was no WHITE category.

To be tagged WHITE in an MCI a person (they are not injured so are not a patient) must:

1) Be ambulatory

2) Have no sign or symptom of illness or injury

 

There, wasn't that easy?  I just saved you 8 backboards and 3 ambulances at your MCI.

The Crossover Podcast Episode 8

Another installment of the blabbling on that is the World’s only crosspolinated podcast is back from the holiday break (we decide when those are, Sparky) and discuss scene safety versus a scene being secure and use the shooting in Tucson as a backdrop.

We also answer a listener question that was phoned in at 313-451-HMMC, which was our all requests oldies hot line, but is now just a drunk dial number for public safety folks to vent (when off duty of course).

So have a listen and let us know what you think about Medics carrying handcuff keys.

Episode 8 – It took you long enough

You Make the Call – Hotel Rooms – What Happened

This scenario was patched together from a few here at home and from around the community.  My service recently ran a call for nausea that included multiple persons in stacked rooms and handled it well.  But identifying the cause or possible causes of the illness can be difficult when multiple possibilities present themselves.

ICS focuses on being the first in and building from the cold zone forward.  This call would be so much easier if we were donning our Medical Group Supervisor vest and carrying the command kit into the lobby control.

Ah, if only life worked that way.  Most MCIs and Haz Mats evolve quickly and rarely come in reported as what we find.

I added the element of the unknown upstairs to make us think about what ELSE could be happening besides the seemingly straight forward CO poisoning call which, had this been contained to two adjacent rooms, is easy to include in our plan.

Medic 88 responded above us, called for a haz mat response and went off the air.  We got neither a status update on their condition or why they called for the haz mat activation so we must assume the worst: They are compromised.

On the 4th floor we have 3 or 4 patients directly needing our assistance with an unknown number possibly dead, dying or completely oblivious to the situation.  The first instinct is to evacuate the building, but scattering our unknown illness may prove more costly than not, so we need to evacuate to a place of safe refuge.

The enclosed nature of hotel rooms gives us the unique option of being able to stage our evacuation from the rooms to the hallway, establishing a warm zone.  Of course identifying those experiencing symptoms will be difficult so we need a way to identify them easily.  The MCI and triage kits are downstairs in the rig, so we’ll need to improvise.  Advise the persons you have already contacted to put on the hotel white robe (if they’re there) or drape a large white towel over their heads.  Asking them to also bring a clean washcloth to cover their coughs will help contain any airborne illness should it be present.  The 2 masks we carry are on us and we are considered contaminated until proven otherwise.

Now we have our original patients easily identifiable and a method to separate them based on signs and symptoms of illness.

This information now needs to be relayed to the other responding units.  Using clear text is key in this situation.  Identify your unit, establish command, list threats and give your status.  If Medic 88 is unreachable upstairs we must include them as victims until we hear otherwise.

For the time being we should stay on the 4th floor, triaging all the rooms who will answer the door.  Symptoms get a white towel/robe and washcloth, non symptomatic get moved the the other end of the hallway from our rooms.

This is no place to establish a command post or begin to orchestrate the response of additional units.  In most communities the first units on scene will be engine companies with basic gear and SCBA, and until we know what is going on upstairs, they should not enter the 4th or 5th floor.

Haz Mat Specialists can speak in more detail as to how they may approach this situation, but leaving what Medic 88 found unknown, I think makes us think in different ways, determining a solution for each possible situation.

Think about the following changes to the scenario:

Medic 88 reports a faulty pilot light on the water heater common to 403, 405, 503 and 505 and that symptoms clear in the hallway.

Medic 88 reports fumes of unknown origin seen coming from room 505, two patients are down inside that room.

Medic 88 calls a mayday and reports they are trapped on the 5th floor in heavy smoke, no SCBA.

Medic 88 stumbles from the stairway with blisters on their faces and arms, excessive snot from their noses and mouths, begging for help.

A hotel employee approaches you stating the hotel has received a bomb threat.

These are all exotic situations we may never see in out careers, but could actually happen when we are already set up for a different event.  Responding to any of these situations allows us to think ahead, set perimeters and stay back from the nasty stuff, but with dispatch systems keen on getting us out the door ASAP, most times without finishing the coding of the call, a simple code 2 sick call can become a dangerous unknown situation.

Think on your feet, use what is around you to your advantage and don’t forget that in this situation, YOU’RE a victim too.  At least until the heroes in the yellow suits say otherwise.

If you said “Slow down and think this through” you made the right call.

Seat at the Table Ep15 – San Bruno Cont’d

Our discussion with Dan Gerrard, Bobby Halton and Jow Telles continues in our special look at building relationships in Emergency Response.

Whether a Chief Officer or Probationary Member, all can learn from this discussion, have a look.

Seat at the Table Success

We had a great day of filming yesterday in San Jose with disaster experts gathered to attend the Tak-Response conference which ends today.

Even though we have not yet found a sponsor to cover the expenses, this opportunity was too important to let pass.

The conference has been a lot of fun, with Thaddeus, Natalie, Jeremiah and Sam Bradley begin_of_the_skype_highlighting     end_of_the_skype_highlighting, the extended Chronicles family, all except Mark.
For a new conference in a new place with a new concept I think it did very well.

I think Kelly Greyson would have enjoyed the shooting simulator side by side with some of the SWAT folks on hand at the show.
And the law enforcement members we did meet were interested not only in what we were doing, but marveling at the wide array of equipment EMS carries, not just a bag and a cot.

Just the show floor was working to break down barriers and let disciplines mingle, imagine what the speakers are inspiring.

The audio difficulties in the filming of the Seat at the Table are well known, but finding a solution we can afford on a negative budget is difficult. We’re trying, I promise.

Today it’s back to the conference with the meetup tonight at Gordon Beirsch Brewery. See you there?

Medic 49 Victor responding

FDNY*EMS Ambulance 485 was the first EMS unit assigned to what Battalion 1 reported as “An aircraft into the Twin Towers.”

This unit, on air as Medic 49 Victor,  was staffed by Battalion 49 Paramedics Carlos Lillo and Roberto Abril.

Roberto chronicled the events of that day in a notebook in his own hand.  The notes can be seen at the website of his partner, who died in the collapse, Carlos Lillo.com

He is one of the EMS Division casualties included in the “343 Firefighters” killed that morning.

From the website:

On September 11, 2001 we lost our beloved FDNY Paramedic Carlos Lillo from Battalion 49, doing what he did best, Saving Lives. Carlos was one of the most admired paramedics in New York City. Carlos showed his courage, dedication, and unwavering commitment to the people of our city, state, and nation with the ultimate sacrifice.

Carlos began his career as a volunteer at Astoria Volunteer Ambulance Corp. in the early eighties, where he went to EMT school. He worked for Associated Ambulance while awaiting his dream and passion to work for NYC EMS. This dream came true in 1984 and it took very little time before Carlos flourished as an EMT, working on a tactical unit in some of the toughest neighborhoods in the Bronx in some of the busiest times the EMS system has ever seen. He then realized another dream: becoming a paramedic. He spoke so passionately about not just being a medic but being the best paramedic, that one couldn’t help but be inspired by his attitude even the old time medics.  Carlos worked for many services within the 911 system where he was loved and respected by all for his professionalism and passion for what he did.

There is a grief that can’t be spoken when you lose someone like Carlos. It is our duty to carry on the tradition of excellence that Carlos lived and to keep his memory alive. Carlos leaves behind the love of his life wife Cecilia, mother Ilia, sisters Iliana and Olga , his brother Cesar and half-brother Alex.

It is in honor of this great paramedic and person that we formed “The Carlos Lillo Memorial Scholarship Fund” to benefit underprivileged students.  Every year we come together to celebrate Carlos during The Carlos Lillo Memorial Golf Outing which was formed to support the scholarship fund with the purpose to help those that want to be and do what he did for us.

Carlos was laid to rest September 14th, 2002.

Hidden in all the “Never Forget”and “343″ stickers and T-shirts are thousands of tales of heroism and bravery, brotherhood and citizenship. Learn one. Pass it along to others.

Please visit the site and learn more about Carlos and how you can help keep his dreams alive.

2009’s story to remember

Explosion hits close to home

As you all know by now a community in the Bay Area City of San Bruno was rocked by a pipeline explosion around 6:45 PM local time.

I first learned about it via twitter, of all things, and immediately went to the news.  There was no coverage yet, so we listened to our radios and heard early reports of an explosion.

Then the tweets started to mention a plane crash and word spread quickly.  As the news began to show aerial shots it was clear from first glance there had not been a plane crash, nor a gas station on fire, as some residents were reporting.  Clearly one of the methods of coping with the complete destruction of your neighborhood by fire is to think of something you saw in a movie.

As we watched on TV from the firehouse, the SFFD responded an entire alarm assignment to assist in what was going to be a full night of firefighting.

Many communities came together as one force for good today.  City, Town, State and Federal teams, as well as private contractors from the local utilities, ambulance companies and certainly law enforcement and highway patrol all had their own duties, but to see how quickly resources were being mobilized made my head spin.

On twitter, I’m suddenly being RT’d (Retweeted) by folks from outside the area trying to get news.

I was asked what kind of plane crashed and if the gas station was still burning.

As fast as resources gathered to confront the gas pipeline explosion and aftermath, rumors and RTs of RTs were spreading half truths and guesses from all over the world.

Indeed the first images and descriptions came via social media, but we must remember to take into account who is giving us the information and where they may have come by it.

It is easy to hit that retweet button when you see something neat, but when it includes information that can not be confirmed or does not cite a reference, confusion can mount.

As I’m writing this at the firehouse, we still have 3 engines, 2 trucks and a Battalion Chief at the scene.  We were listening to the channel for awhile and even heard the crash truck from the nearby airport report they were full with 4500 gallons and ready to help.

I’ll be passing along what information I have, but am very interested to meet some of the responders at next week’s Tak Response Conference.  Imagine a conference specifically about inter-agency co-operation and training happening so close to such an event.  The information fresh in the minds of all persons involved will be an amazing learning opportunity for us all.

If I can, I want to get some of them a Seat at the Table on Wednesday the 15th and get their side of what happened.

Stay safe,

HM

Gearing up for Tak Response

Over the next few weeks you’ll be hearing from me about the Tak Response Conference in San Jose coming up September 14th-16th.

Chronicles of EMS was invited to be a part of this collaborative training opportunity that will bring the best of all fields together to network and learn from each other.

This conference combines nursing, Fire, Haz-Mat, law enforcement, SWAT, EMS, public works and a number of other disciplines together, since when we all arrive on scene we have to work together.

Let’s start to train together.

Tak Response is not only a chance to learn from other disciplines where you fit in at “their” scene, but to network socially with your fellow providers before the you know what hits you know where.

Imagine a scene where the Battalion Chief, Patrol Officer and EMT all already know each other and what each agency expects from the others.  That’s a smooth running scene.

Here’s the episode of Seat at the Table where we meet the organizers of the Tak Response Conference and run the concept by paramedics, firefighters and even a cop.