A Multiple Casualty Incident Part II -- A Small Dose of EMS History

'Pt. hx' is the medical terminology abbreviation for 'patient history.' Just a factoid I thought I'd share in light of how this story is blossoming into an inadvertent retrospective. Anyway...

If you’ll recall, we left off in a :  A mass casualty incident (MCI) involving a collision between a bus and three vehicles in a designated parking lot across the street from The series of drills/training conducted by the Murrieta Fire Department in tandem with the Pechanga Fire Department and a variety of public agencies occurred last week because once an MCI has been declared by the first arriving unit, a coordinated flow of events occurs in three phases: triage, treatment and transportation.

The roles of the make-up director, Alexis Miura, as well, her coterie of thespians, had been organized by Murrieta Mesa drama instructor, Christopher Ryan, a couple of weeks before the mock disaster. That’s the eternal conundrum of disasters: sometimes we can predict their arrival in all preparatory glory by practicing intervention for the worst-case scenarios similar to the MCI drill, or by methodically evacuating those people in harm’s way as with those who were residing in southeast Louisiana just days before hurricane Katrina deluged New Orleans in August, 2005.

Further, we can watch the dynamics and location of turbulent weather as it emerges on Doppler and satellite systems. Whether we follow our survival instincts during the prior, or make it through an unnatural, criminal assault --though highly improbable -- significant, life-threatening events can manifest out of the clear, blue sky at a Sunday air show, or on a seemingly open, long stretch of road.  Yes, even in a beauty salon, in the tech company workplace, or in a guarded, Tulsa, Oklahoma courthouse – Poof! Justlikethat! You’re involved, somehow, some way, some place!

Chaos, street violence, vehicle wreckage flying like projectiles through the dense air of frightening suspense is the harangue of reality television shows, of news broadcasts, of YouTube videos dancing in our daily dose of media. Without disaster, perceived or real, small or grand, heck, there would be no interesting tale of woe, of subsequent heroism or of miraculous survival.

Back in 1966, a report entitled: Accidental Death and Disability: The Neglected Disease of Modern Society (The White Paper / U.S.) showed that soldiers wounded on the Vietnam battlefields had a better chance of surviving traumatic injuries than civilians seriously injured in a motor vehicle accident on California freeways. No kidding? Subsequent to the report, the Federal government (via Department of Transportation www.dot.gov) outlined standards for ambulance attendant training, for medical equipment and for emergency vehicle design, incorporated into the Federal Highway Safety Act.

It was more than a safety act when, in 1969, the Los Angeles County paramedic training program was implemented in association with Harbor General Hospital under the auspices of Michael Criley, MD and James Lewis, MD, while many other paramedic programs developed across the nation as well.

I mention that historical tidbit because ‘field medicine’,  ‘pre-hospital care’, ‘advanced life support,’ evolved on the heels a momentous television show entitled, Emergency! The show premiered in 1972 (Netflix offers the relic series). 

I was a 15-year-old, wanna-be doctor, until I watched and learned what the main characters of the show, John Gage and Roy DeSoto, were practicing as pre-hospital care providers, even if it was fiction. In reality, there were six paramedic units operating in three pilot programs in the U.S. at the time, according to Wikipedia.

When Emergency! ended in 1979, paramedic programs existed in all 50 states and as the profession evolved, an emphasis on rendering advanced treatment at the scene of an incident first, then stabilizing the patient while en-route to the hospital, did away with quickly loading the patient and transporting to the nearest emergency room. 

Does anyone else remember the elongated, Cadillac ambulances which faded away with the advent of van conversions and modular chassis? I learned to drive, code three, in each type of vehicle. Cadillac's suspension system remains unparalleled on bumpy roads.

As a footnote, 911 had yet to be implemented as the universal, emergency number and emergency room physicians, as specialists, didn't exist.

In 1981, I graduated from Crafton Hills College in Yucaipa (of all places) as a paramedic after conducting my field training with the L.A. City Fire Department Task Force 15 located directly across the street from the USC campus on Jefferson Avenue.

There were two, pivotal things I learned to initially assess on a patient(s), no matter the chief complaint: ABCs (Airway, Breathing, Circulation) and triage in the case of an MCI -- the latter nomenclature didn’t exist back then, either.

There would be no evolving, systematic approach to managing field incidents derived from military battlegrounds where entropy demands some semblance of  order to medically treat soldiers who, on initial assessment, stand a chance to survive extremely traumatic injuries. That initial assessment of many victims by a trained, medical professional precludes rendering any medical intervention other than the basic head tilt for airway management and includes tagging the victims (triage tag in the photo above), for lack of a better term, via triage.

Triage is a French verb meaning to sort. In a predicament where many are injured and resources are limited, the wounded are divided into four categories, regardless of the medical care received:

•  Minor Injuries: Walking wounded. Likely to live.
•  Delayed: Injuries aren't life threatening. Require medical care at some point.
•  Immediate: Major, salvageable injuries sustained. Immediate care is needed.
•  Expectant: Fatal injuries and/or DOAs.

Triage tags are placed around the necks or ankles of victims to keep track of them electronically by scanning the bar code embedded on the tag. The information is reported to incident command located at or near the site of the disaster. Triage originated in WWI on yet another battlefield during the Napoleonic War...

To Be Continued