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Practice makes perfect: EMS personnel train for mass casualty incident

Fire District No. 3 EMTs Rozalind Plumb and Sam Jensen tend to an “injured” Janet Holen during last Saturday’s mass casualty incident drill. Fire District No. 3 and Klickitat County Emergency Medical Services District No. 1 coordinated the training exercise.

Photo by Sverre Bakke
Fire District No. 3 EMTs Rozalind Plumb and Sam Jensen tend to an “injured” Janet Holen during last Saturday’s mass casualty incident drill. Fire District No. 3 and Klickitat County Emergency Medical Services District No. 1 coordinated the training exercise.



It was a warm and windy Saturday afternoon on which the agitated husband yelled at the first emergency medical responder to arrive at the scene of the car-bus accident. His wife, who was driving, got ejected from the driver’s seat and came to rest on her back, just outside the open door.

“My wife is hurt! She’s not responsive! She needs help!” he screamed as the first responder tried to soothe him while she quickly assessed the unconscious woman’s injuries.

Soon after, a team of two responders took over. They eased the woman into a flexible nylon stretcher with nylon handles on either side and carried her to a makeshift triage center for more intensive care by teams of ambulance personnel.

Eventually, medical personnel deemed the woman the most serious case and loaded her onto an ambulance for transport to hospital. Her husband, still somewhat disoriented, accompanied her. (A request was made to Life Flight to put a helicopter on standby, but the request was later cancelled.)

At the same time, emergency medical responders began surveying the 17 injured on the school bus. Head injuries and leg injuries were the most prevalent.

Those that could walk on their own to the triage center were asked to do so. Those that couldn’t were put in flexible body stretchers and carried down the aisle and off the bus by emergency personnel. The ranks of the injured in the triage center swelled with the arrival of the men, women, and children from the bus.

Ambulances kept rolling into the triage center, and the most seriously injured people kept rolling out in them as responders worked to clear the triage center of the remaining cases.

So played out the mass casualty incident drill conducted last Saturday behind the Husum Fire Station by a small force of fire and rescue, and ambulance personnel.

The exercise took place under the auspices of Klickitat County Fire Protection District No. 3 and Emergency Medical Services District No. 1. Fire District No. 3 and other local agencies provided fire and rescue personnel, while Hadassah Management Systems furnished the paramedics and EMTs. (Hadassah operates ambulance services for EMSD No. 1.)

Citizen actors, notably Skyline Foundation members Roger and Janet Holen, of White Salmon, and student members of the Air Civil Patrol participated as the victims. At least one of these volunteers came from as far away as Aurora, Ore. The White Salmon Valley School District donated the bus to Fire District No. 3 specifically for training.

David Nice, training officer for EMSD No. 1, said the exercise enabled the fire and ambulance services to work together in the process of rescuing victims, triaging and prioritizing them, treating their injuries, coordinating hospital destinations with the local Medical Resource Hospital, and transporting patients.

“The purpose of the exercise was not only to practice, but to identify areas for improvement, both individually and as a system,” said Nice, who served as an observer during the drill.

“Because we do not have many mass casualty incidents, it is important to practice the skills in as realistic a situation as possible,” Nice continued. “It has been proven over and over that people will perform as they practice.”

Bruce Brending, of Hadassah’s operations division, served an evaluator of the multi-agency drill.

“To be as real as possible, [the] actors were made up with various injuries, from minor to life-threatening, and they were coached to be crying, yelling, and confused to add realism to the accident scene,” Brending noted. “All of them did a great job and greatly enhanced the training experience for all of the emergency responders who participated.”

Brending pointed out, moreover, that multi-agency cooperation in such instances is critical to the best possible outcomes in a mass casualty emergency response. “Since the formation of the EMS District, it has only become even better, as demonstrated by all that participated in this incident,” he said.

Rozalind Plumb, a Fire District No. 3 EMT, said she has taken part in a couple of similar training exercises “and there is always so much to learn from them.”

She said the drills can be very chaotic at times “with that many patients and so few responders to care for them during mass casualty incidents.”

EMTs get stretched thin, Plumb continued, and simply do not have time to spend with every patient as they normally would, “but it has to be that way to reach the real goal of getting the patients away from the scene and on to definitive care at the hospitals.”

Plumb added, “Training like this teaches the most effective way to triage, or sort, multiple patients and identify the most-injured people quickly.”



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