# Mass Casualty Training



## CityEMT212 (Jul 31, 2018)

Hi EMS Family,

Do your agencies do routine MC Trainings or drills? I'm hoping to participate in one upon my course completion.

https://www.ems1.com/patient-handli...esponse-transporting-patients-from-the-scene/


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## DrParasite (Aug 6, 2018)

Airports complete full scale drills annually or every other year; I believe it's an FAA requirement.

I know that many volunteer agencies will try to do one every year; I don't know of many paid agencies that participate in mass casualty drills, because they don't have the staffing or budget to send one or two staffed units to a drill.

Once you complete your course, and become affiliated with an agency, your opportunities open up greatly.


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## johnrsemt (Aug 6, 2018)

Yea;  we do MC training yearly at my FT job.

PT at least every 2 years.   Bad thing at PT job if it happens in real life;  backup by ground is 90 minutes to 2 hours away.  Helicopters are 45 to 75 minutes away,  fixed wing are 60 minutes to 4 hours away.    We have up to 5 ambulances (crews will be tough);  2 fire departments, 6 police departments ( we straddle state line)
  And the closest hospital is 105 miles one way.


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## DrParasite (Aug 6, 2018)

johnrsemt said:


> Yea;  we do MC training yearly at my FT job.


John, what does your yearly MC training consist of?


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## Jim37F (Aug 6, 2018)

Our department just rolled out "Active Threat" training (active shooters, bombings, terrorists, etc etc). Basically, the idea being Cops go in first to hunt down the shooter(s) and "Stop the killing" (shoot the shooter)...They (the cops) will have guys posted in hallways and rooms to establish a Warm Zone....and then a Rescue Task Force (Fire and/or EMS with a police escort) will move in, under PD cover to Casualty Collection Points inside the Warm Zone, do rapid triage that was modified from START to basically focus on stopping bleeding (Tourniquets basically #1 treatment, with pressure dressings and occlusive dressings following), just enough to keep them alive for the RTF to extricate them to an Ambulance Exchange Point where the casualties are either taken directly to the trauma center or to a secondary triage site in the Cold Zone (depending on size and scope of the incident and resources available).

Everyone went thru a day of training on it, some classroom/powerpoint time and then a handful of scenarios where we applied tourniquets and hauled each other around on Mega Movers for an afternoon. I think the intent is to do this annually, but we'll see. Supposedly we're supposed to get more TECC training sometime early next year.

Though the training is only open to our Dept, and the EMS and Police Dept. guys as well, not something a civilian can sign up for. Though I suppose if AMR wanted to take part (they're the only private ambulance company here) they probably could get that coordinated (personally I think they'd likely end up involved in a real-world incident just due to the sheer number of resources required would lead to mutual aid being called) Beyond that, maybe if you're on the City Council and/or FIre Commission you could get yourself invited as an observer to one of the training sessions?


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## DrParasite (Aug 6, 2018)

Jim37F said:


> They (the cops) will have guys posted in hallways and rooms to establish a Warm Zone....and then a Rescue Task Force (Fire and/or EMS with a police escort) will move in, under PD cover to Casualty Collection Points inside the Warm Zone, do rapid triage that was modified from START to basically focus on stopping bleeding (Tourniquets basically #1 treatment, with pressure dressings and occlusive dressings following), just enough to keep them alive for the RTF to extricate them to an Ambulance Exchange Point where the casualties are either taken directly to the trauma center or to a secondary triage site in the Cold Zone (depending on size and scope of the incident and resources available).


not to jump off on too big of a tangent, but that is the first active shooter response that I have heard that involves cops posted in hallways and then the RTF goes in under PD cover.  

everywhere else I heard said PD goes on the hunt for the shooter, while the RTF is doing triage (with police escort) and stop the bleed and establishing a CCP in a secure room.


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## Jim37F (Aug 6, 2018)

DrParasite said:


> not to jump off on too big of a tangent, but that is the first active shooter response that I have heard that involves cops posted in hallways and then the RTF goes in under PD cover.
> 
> everywhere else I heard said PD goes on the hunt for the shooter, while the RTF is doing triage (with police escort) and stop the bleed and establishing a CCP in a secure room.


Yeah, the concept envisions a fire company with at least 2 cops forming an RTF, (preferably 4 cops and 4 Fire/EMS) and having visual contact with additional cops posted in the hallways and the Room Boss at all times...this, of course, means even a small building will have tons of cops...but any incident like that will probably get tons of them showing up anyway (in theory at least).

So yeah, RTF includes police escort as part of the TF....plus LEOs pulling security in the Warm Zone, while (depending on size and scope) the LEO Contact Team has either stopped the shooter or if it's big enough still running towards the sound of gunfire, their job simply to radio in casualty locations and bypass them to go shoot the bas****, while other cops will (ideally) move in behind them to secure the warm zone for the RTF to get in and do bleeding control and extrication.

Of course, I can only imagine how many different ways this can break down in a real-world incident, (if nothing else table talks between the chiefs in each dept and both depts at least having been briefed on their roles should help)


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## johnrsemt (Aug 6, 2018)

Dr Parasite:  Varies year to year;  we have had a couple of mass shooter MC training;  some have gone well some haven't.   First one I was involved in the 'shooter' added something that no one knew about;  he tossed a smoke grenade outside a building away from the high school.  It went out as a fire at a building.  Fire, PD and EMS set up their command post before we 'knew it was a mass shooting':  It took weeks to convince them that we can't do that.  In real life we don't set up command posts for every building fire.    It took awhile but they finally got it.
   Bus crash,  airplane crash (we have planes with up to 200 paratroopers so that can be interesting it there is a problem.

PT job,  fire and explosion at casino/hotel.  Plane crash.  Bus Crash.  etc.


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## DrParasite (Aug 7, 2018)

johnrsemt said:


> Dr Parasite:  Varies year to year;  we have had a couple of mass shooter MC training;  some have gone well some haven't.   First one I was involved in the 'shooter' added something that no one knew about;  he tossed a smoke grenade outside a building away from the high school.  It went out as a fire at a building.  Fire, PD and EMS set up their command post before we 'knew it was a mass shooting':  It took weeks to convince them that we can't do that.  In real life we don't set up command posts for every building fire.    It took awhile but they finally got it.
> Bus crash,  airplane crash (we have planes with up to 200 paratroopers so that can be interesting it there is a problem.
> 
> PT job,  fire and explosion at casino/hotel.  Plane crash.  Bus Crash.  etc.


Sorry, I wasn't clear in my request: what I meant to say is what do YOU (as the street level provider) get to do at the MCI training?  and does your entire department participate, or only specified units?  Do you recall an entire off duty shift?  What if its your regular work day?

The last MCI drill I attended was at Newark Airport; I don't remember the details (I think there was an issue in the terminal and on the plane, because we had two operations running simultaneously, one ramp side, and one street side), but there were definitely more volunteer ambulances than career ones in the staging area.  Most career agencies sent one ambulance, and their Special Operations Vehicles (we sent several white shirts, all of our off duty SOG personnel, several mass casualty units, and one ambulance), while many volunteer agencies brought two ambulances with 3 people per truck.  So if you were working that day, or already scheduled for your other job, you didn't get to participate.

I know many FD (like @Jim37F stated) allow their units to to OOS for training, but I don't know many EMS agencies that do this; this barely have enough units to cover the call volume as is, so taking one or two out of the system would cause a further strain on existing resources.


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## Peak (Aug 8, 2018)

Our MCI training is more about patient movement and planning than anything hands on, we have drills at least once a year.

The difficulty is that nobody can predict what the next MCI will actually be. A couple of years ago there was food poisoning at one of the homeless shelters causing hundreds of patients with profound nausea/vomiting/diarrhea overwhelming both EMS and multiple EDs in the downtown/metro area. When I was on fire we often spent more time organizing care/transport for horses and livestock than humans, but that wasn't something that we actually trained for.


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## CityEMT212 (Aug 20, 2018)

DrParasite said:


> Sorry, I wasn't clear in my request: what I meant to say is what do YOU (as the street level provider) get to do at the MCI training?  and does your entire department participate, or only specified units?  Do you recall an entire off duty shift?  What if its your regular work day?
> 
> The last MCI drill I attended was at Newark Airport; I don't remember the details (I think there was an issue in the terminal and on the plane, because we had two operations running simultaneously, one ramp side, and one street side), but there were definitely more volunteer ambulances than career ones in the staging area.  Most career agencies sent one ambulance, and their Special Operations Vehicles (we sent several white shirts, all of our off duty SOG personnel, several mass casualty units, and one ambulance), while many volunteer agencies brought two ambulances with 3 people per truck.  So if you were working that day, or already scheduled for your other job, you didn't get to participate.
> 
> I know many FD (like @Jim37F stated) allow their units to to OOS for training, but I don't know many EMS agencies that do this; this barely have enough units to cover the call volume as is, so taking one or two out of the system would cause a further strain on existing resources.



Here in NYC, there are opportunities for civilians to participate in MCI training through some city programs that educate individuals in Emergency Responses. I've participated in a couple, a few years ago, but am interested in joining one as an EMS member when I join an agency. The thing with that is, not all agencies offer this (as previously mentioned), and although joining something like MedCorps will put me on standby for a real response, the training is invaluable and I'm not sure where I can seek involvement for something like that.


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## CentralCalEMT (Aug 25, 2018)

We (private company) try and do MCI training at least once to twice a year. We are a rural area with one community hospital locally, a level 3 trauma center 30 miles away and a level 1 trauma center 75 miles away so we do not have many resources.  The scenario changes each time. One time we used a decommissioned bus donated to the FD for training which was good since we could take out windows or doors or whatever we needed. Another time we simulated a vehicle versus a large crowd. 

The most recent was an active shooter  large scale drill at a local high school. That one required a lot of meetings and coordination and it requires people willing to put in the effort and time. Fortunately we have an excellent working relationship with a local high school (this year we taught all staff Stop the Bleed) which made it easier for me to walk into a meeting and respectfully request the use of an entire campus for an entire weekend day. We also had 3 PDs, 3 BLS FDs, and my agency at the drill. We had many off duty people go as well as some people on overtime detailed to the drill so we actually had 5 reserve units staffed, dedicated to the drill. (Our daily staffing is 5 units so it was what they would get if an actual MCI happened.) The local hospital sent MICNs to observe so they can get an idea of what an MCI would be like from our standpoint. 

By offering CEUs we attracted many off duty employees, both EMTs and Paramedics who staffed some of the units. We also had our paramedic interns attend and invited the local EMT class who sent 10 students. For non public safety participants, we used around 30 high school students from the high school's Health Sciences Academy first responder course who simulated our patients. Also we had another 100 or so students who were instructed to run around and get in our way so it was more realistic and more uncontrolled and they did a good job of that. All high school students got community service hours for their assistance. All told, we had about 200 total participants involved from all agencies and the school. 

The first part was a classroom session on the Rescue Task Force model as well as triage, and how to set up a treatment area. We had several of these sessions the week before the drill and also offered CEUs for it so most participants in the drill had this class before the actual drill. 

The day of the drill, we all met up an hour before the drill. The students (including 2 police explorers who were the "shooters") position themselves at locations around campus. We told them to pick their locations so we had no idea where the victims/shooters/other students were. The drill happened in real time. For instance, the first 3 PD units formed up a contact team, and subsequent responding officers formed another one. Subsequent officers formed up rescue task forces with FD/EMS. Next in EMS units set up treatment areas and a staging area was set up for the ambulances. The important part of all this was timing. All resources do not show up the same time. We had the first engine "arrive" in 4 minutes, the second in 6, the third in 8, etc. Same with the EMS units. This way we had to grapple with lack of resources to begin with.

Overall the drill went well and we learned where we can improve. Next year, we are going to use staff who volunteer as "immediate responders" to practice bleeding control in the classroom before we even can make access.  

My point with this lengthy description is it is possible to pull off a realistic drill no matter your size or resources. It just takes a lot of work. We are a small agency, in a rural medium sized city, with limited funding, resources, and personnel. PD/FD had the same constraints. However, with the right effort and collaborators, it is possible to pull off a full scale drill. Thanks to the cooperation we were able to carry out the drill.


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## johnrsemt (Aug 28, 2018)

It is great that you could do it in real time;   the 1st time we tried to do a Mass shooting exercise here, the county 'SWAT' team showed up in 5 minutes, which I thought was pretty good since they are normally 30-45 miles away.


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