My First MCI

[spenac]

Being triage officer sucks if you ask me.

It really does. I hate having to walk up and tell someone begging for help that help will be there shortly. Because we have no back up often we will work on multiple patients but sometimes you can't save them all, and making the decision of which ones to basically ignore haunts you.

Sadly the city/county cares more about the dollar than the people. At least my current full time job is determined to keep increasing number of ambulances which my old full time current part time felt that way.

[CBEMT]

Fiz,

Your story is exactly why I almost never bring anything except c-spine equipment to the patient's side at an MVA. It's just not worth it. Even if it's a trauma code, there's not a whole lot I'm going to do on the side of the road that can't be done safer and more effectively inside the truck after immobilization.

And if you really think about it, to some degree this is one situation where tunnel vision isn't the end of the world. Other than your own safety, the extrication going on wasn't your concern, because your patient wasn't in it. You were assigned your patient, treated, and transported. Nothing wrong with that.

[Arizonaffcep]

The scene was chaos though, with firefighters and police yelling at the top of their lungs

Well, to quote Dust, "FAIL"! Not a personal fail, but a fail for scene control. As one who, when I was with the FD, would run on what was euphemistically called a "bean spill" (a vehicle FULL of undocumented aliens--no, the ones from south of the boarder--that has rolled, on average with 10+ people) about every other month or so-take it from me, the worst thing to happen is to not have control of the scene. The fly medic should have taken command, with the thought that the next due unit would initiate START triage (what is used in Southern AZ). Then...sort out your patients and send them off as appropriate. Honestly (this is not a ding on you or your crew...so please don't take it that way) but the way we ran things was the first transport in was the last one out. The thought on this was because our manpower was limited, the first transport (from our department) would take the Triage Officer position, and coordinate with the staging folks to get other units into the scene. Actually, it worked very nicely, obviously, the "reds" would be the first off the scene. And to top it off, (aside from the 20 mile stretch of part of the I-10, which is one of the deadliest parts--no not from providers :twisted: --we also have a railroad which as AMTRAK as an occasional user running through the district) so we would also run training scenarios where the AMTRAK train derailed and had 100+ people as patients.

Here is a link for the ICS=100 course through NIMS: http://training.fema.gov/EMIWeb/IS/IS100a.asp

There are several if you want to take them, they are free and decent knowledge. If you REALLY want good ICS stuff, check this book out: http://books.google.com/books?id=T9Gz2Vnr6...=result#PPP1,M1

(should be Alan Brunacini's IMS book)

I know a LOT of people here are against fire doing EMS stuff (can't say I disagree) but, Alan Brunacini is the retired chief of Phoenix Fire, and he literally wrote the book on which the national stuff is based on. The cool thing is, IMS (incident management system) along with NIMS stuff can and should be used for any event, which requires a multitude of responders. The only difference in them is the sectors/divisions/groups (whichever is appropriate for local terms). Other than that, they are all the same. Hope this helps!

[Arkymedic]

The book Incident Management For the Street Smart Fire Officer by John "Skip" Coleman is outstanding as well. It is mostly geared towards FD BUT, there are strong ICS lessons for everyone. We used this book for a few different courses in my EAM bachelors program and I highly recommend it.

Well, to quote Dust, "FAIL"! Not a personal fail, but a fail for scene control. As one who, when I was with the FD, would run on what was euphemistically called a "bean spill" (a vehicle FULL of undocumented aliens--no, the ones from south of the boarder--that has rolled, on average with 10+ people) about every other month or so-take it from me, the worst thing to happen is to not have control of the scene. The fly medic should have taken command, with the thought that the next due unit would initiate START triage (what is used in Southern AZ). Then...sort out your patients and send them off as appropriate. Honestly (this is not a ding on you or your crew...so please don't take it that way) but the way we ran things was the first transport in was the last one out. The thought on this was because our manpower was limited, the first transport (from our department) would take the Triage Officer position, and coordinate with the staging folks to get other units into the scene. Actually, it worked very nicely, obviously, the "reds" would be the first off the scene. And to top it off, (aside from the 20 mile stretch of part of the I-10, which is one of the deadliest parts--no not from providers :twisted: --we also have a railroad which as AMTRAK as an occasional user running through the district) so we would also run training scenarios where the AMTRAK train derailed and had 100+ people as patients.

Here is a link for the ICS=100 course through NIMS: http://training.fema.gov/EMIWeb/IS/IS100a.asp

There are several if you want to take them, they are free and decent knowledge. If you REALLY want good ICS stuff, check this book out: http://books.google.com/books?id=T9Gz2Vnr6...=result#PPP1,M1

(should be Alan Brunacini's IMS book)

I know a LOT of people here are against fire doing EMS stuff (can't say I disagree) but, Alan Brunacini is the retired chief of Phoenix Fire, and he literally wrote the book on which the national stuff is based on. The cool thing is, IMS (incident management system) along with NIMS stuff can and should be used for any event, which requires a multitude of responders. The only difference in them is the sectors/divisions/groups (whichever is appropriate for local terms). Other than that, they are all the same. Hope this helps!

[fiznat]

Yeah I've got ICS 100, 300, and 900, but it seems difficult to apply a lot of that stuff when you're there on the side of the road and patients need *your* help now. There isn't a lot of time to sit back and apply theory, which is sortof the point I was making with this thread. It seems to be really good and efficient at this kind of thing you need practice, but who really gets that much practice with bad MCIs?

Maybe we should be running more drills with this kind of stuff or something. I'm not sure. Perhaps thats a better question: does your service run regular full-scale MCI drills and do you feel practiced enough to handle "the big bad one" efficiently and effectively?

[Arizonaffcep]

...but who really gets that much practice with bad MCIs?

Maybe we should be running more drills with this kind of stuff or something. I'm not sure. Perhaps thats a better question: does your service run regular full-scale MCI drills and do you feel practiced enough to handle "the big bad one" efficiently and effectively?

Table top exercises! Get out (I'm serious here) some matchbox cars/trucks/whatever and set up a scene. Practice like you play. Get the radios, set up a formal command structure, etc. etc. It's the only efficient way to do it. Also, if you really want to get cool about it, don't know where you are, but if in the U.SA., get in contact with Border Patrol, see if they have any confiscated cars they would donate to your department. You typically have to pick them up, but hey, they're free, right? Really good for multi-agency drills, stage the cars in ways to be realistic (without having a person crash them...). From there, have patients inside, who can act their part. Moulage them and run that as a drill. Not as economical as the table top exercise, but more fun. Hope this helps!

[Arkymedic]

Table top exercises! Get out (I'm serious here) some matchbox cars/trucks/whatever and set up a scene. Practice like you play. Get the radios, set up a formal command structure, etc. etc. It's the only efficient way to do it. Also, if you really want to get cool about it, don't know where you are, but if in the U.SA., get in contact with Border Patrol, see if they have any confiscated cars they would donate to your department. You typically have to pick them up, but hey, they're free, right? Really good for multi-agency drills, stage the cars in ways to be realistic (without having a person crash them...). From there, have patients inside, who can act their part. Moulage them and run that as a drill. Not as economical as the table top exercise, but more fun. Hope this helps!

Table tops are excellent resources when conducted correctly. One of the downsides is that people do not understand developing exercises, and usually confuse what type of exercise to run and when to do it. We use them frequently in emergency management and they are a great tool. There are also a few computer simulations and there is a program called Code3D where you can create a scenario, timeline, the whole works. I learned a phrase a long time ago that is absolutely true "Prior Planning Prevents Piss Poor Performance".

[Fox800]

Ah...the joys of the "what if?" Game. Do I direct my next-in ALS crew to the most critically injured but still entrapped pt., or send them to transport a slightly-less-critical, but extricated and immobilized pt.?

[toutdoors]

Fiznat, you know what may help is if you get the opportunity to be an evaluator at a MCI disaster drill. Even if you do not feel comfortable being an evaluator, ask if you can tag along with one and just watch what the responders do. It is amazing how much I learned from my first drill that I was an evaluator at. You actually get to see the big picture with no emotion or personal investment. You just sit back and watch the show unfold. You get a unique opportunity to see how easy it is for a responder to miss what seems to be a very simple yet important piece of the puzzle at times.

We should all remember that drills are intended to be positive learning tools, and not a chance for some paragod or rescue randy to point out all the small things they witnessed, but rather a way to improve upon our current response and preplanning.

I have been involved in numerous drills, as a firefighter, medic, US&R rescue specialist, I have even been the IC for a very large drill in our department a couple of years ago. The cool thing is that you learn alot more about a disaster everytime you drill, and hopefully get to "wear a different hat" at times. As the old saying goes "walk a mile in my shoes" This is when you get to really put the entire picture together and appreciate what exactly is going on at different levels of the command system and operations sector. Like I said earlier though, getting the chance to just watch a drill unfold allows you to just sit back, relax, and see how things get done, and answer to yourself how you may have handled certain aspects of the scenario.

I still think you did a good job though.