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Health & Fitness

A Multiple Casualty Incident Part III: Disaster Waiting To Happen

Multiple Casualty Incidents Part III. Triage. MFD CERT Training. Community Disaster Preparedness.

The Incident Command System (ICS) is a tool used to coordinate an emergency response involving more than the first-in unit. The first responder takes charge of the scene, declaring command until the incident is resolved, for example: a vehicle accident, a structure fire, a law enforcement operation, a hazmat incident. ICS was developed in the 1970s because many a local, state, national and federal agency showed up to help with wildfire suppression in California, though the agencies may not have been ordered to do so. Communication between the agencies fell short, as did general accountability. ICS is now a global standard for scene management by objective.            

, we took an on-site journey through a mock, mini-disaster, a bus versus three cars, staged adjacent to Murrieta Mesa High School, Feb. 28 - March 2. As a training venture, Capt. Eric Ballard teamed up with Murrieta Mesa High School (MMHS) drama instructor, Christopher Ryan and his fledgling actors, tapping into a dramatic portrayal of injured, teenaged victims.

Black’s Towing situated the crushed vehicles just so. The Pechanga Fire Department (PFD), the Murrieta Police Department (MPD), and MMHS security each participated in their respective roles. AMR, Symon’s, and Mission ambulance personnel treated and really did transport the mock victims to local hospitals.

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Part II of this series of articles included a brief history of how emergency medical services (EMS) came into fruition on the heels of one, 1966, U.S. report entitled: Accidental Death and Dismemberment: The Neglected Disease of Modern Society. Fundamentally, the EMS White Paper published by the National Academy of Sciences rendered startling statistics pertaining to accidental injury, disability and death, about which I’ll spare you, other than to say that in 1965, a severely injured person had a higher survival rate on a battlefield than on a U.S. highway by virtue of rapid, medical intervention.

I remember ambulances and the attendants in the mid-1960s: I was a very young child when I witnessed a family friend, Mary, collapse, face down, in her living room. Her eldest son, Mike, was on leave from the Air Force. He was wearing his uniform. He commenced to doing those things we learn in CPR class, all the while, torn between wiping the sweat and the tears from his face, or removing his insignia-decorated, wool jacket to take a breather. He did neither.

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I remember watching the ordeal from between my pink, patent leather shoes as I quietly sat in a far corner of the couch. Hovering over his mother, Mike continued with rhythmic, chest compressions as his deep, breathless, cracking voice counted out loud, “One and two and three and four…,” all the way to 15. Then quickly adjusting his broad, kneeling stature, he exhaled two, deep breaths into his mother’s lungs. I could see Mary's chest rising with each blast of air her son shared from the depths of his being.  

After a long while, two men dressed in a starched, white get-up, wheeled the gurney in, picked Mary up from the floor, then wheeled her out to one of those elongated, Cadillac ambulances I spoke of in  My educated guess is that Mike continued CPR all the way to the hospital, some 20 minutes away, because Mary survived. 

Funny thing back then: 50 percent of ambulance services were provided by 12,000 morticians because hearses could accommodate gurneys. The two men who showed up to transport Mary were neither trained nor equipped to provide basic, emergency medical care because national standards didn’t exist. In fact, fire departments didn’t respond to medical calls back then for the same reason. There were no EMTs or paramedics or 911. Mothers. Necessity is the mother of invention.

Really, triage wasn’t invented, per se. Triage is almost an intuitive process because in Part II of the series of articles, I left off with the meaning of the word and the practice of such. In any situation where many people are injured and the resources to help them are scant, the injured are divided into four categories, regardless of the medical care received:

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

Triage was one of the first things I learned to conduct in my paramedic and subsequent training as an RN. When frantic, disoriented, crying, bloodied victims are meandering through unstable debris, the first person I was taught to triage is me (in a manner of speaking). Let’s face it, emergency situations are never expected, at least not in my mind.  

Likewise, disasters waiting to happen may never manifest—though in flipping through the TV channels these days, astonishing, human foible dominates. Sylvester Stallone, Bruce Willis, The Rock, Clint Eastwood and Vin Diesel are purely fictional action heroes. In reality, each would do well to take care of their own in a major incident, as would the general public. Truly, if I become injured or ineffective in an emergency, I wouldn’t be able to help anyone. I’d be out for the count.

Hence, I wasn’t counting on attending the entire CERT (Community Emergency Response Training) program hosted by MFD, Firefighter/paramedic and CERT Coordinator Dan Wilson, Capt. Eric Ballard, Engineer Matt Bentley, Firefighter/Paramedic Brandon Roach, Engineer Mike Macalinao and Explorer Post 630, Junior G-Men. 

From March 9 to 11, MFD offered a 19-hour, FEMA-funded course to train local citizens in managing the basics of a large-scale incident. I was convinced to stay the minute I met all the earnest people in the class, not to mention the great snacks, the bottled water and the fresh coffee. So, the question remains: What are the basics?

“We train the class to do the greatest good for the greatest number of people. The action begins in the surroundings in which people find themselves,” Wilson said. Things happen in the workplace, on the school campus, on the freeways, in the neighborhood.

“Once CERT members determine their own safety and that of their families, we encourage them to step out into the neighborhood,” Wilson said. “The first day of class, we give them some tools to do that, followed up with some hands-on training on the last day of the brief program."

“We have a minimum of one paramedic on response units. Our crews are trained to manage everything from heart attacks to disasters. Fortunately, large-scale incidents are rare, which is why it's important to continuously train and prepare for all scenarios. We have the equipment to initiate care. We don’t hesitate to call for additional resources once our incident commander sizes-up the magnitude of the situation,” said fire Chief Matt Shobert.     

To Be Continued…

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