# Mass Casualty Units



## traumaluv2011 (Aug 29, 2011)

I'm sure you might have seen one of these (either in bus form or box truck form). This is our county mass casualty bus that I think fits 12 patients. It's coming to our building on Wednesday for a demonstration for a few squads nearby. Anybody have any actual experience with one of these? 

Here is the one I'm talking about:
http://sartinservices.com/sartin_services_news/news/







If you click that link and scroll all the way down, there are pictures from a mass casualty drill


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## usafmedic45 (Aug 29, 2011)

Eh....honestly, I've always thought that the idea of a bus as an oversized ambulance was probably devised by someone who has never responded to a school bus accident.  For the cost of obtaining outfitting and maintaining one of these, you probably could purchase, stock and maintain in reserve quite a few BLS ambulances that would have much more utility in a "The sky is falling! The sky is falling" MCI.  With the hooks you find in most military ambulances, you can transport four litter patients in a standard box ambulance.  So much easier to drive especially in areas with marginal road infrastructure.


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## jemt (Aug 30, 2011)

Elizabeth,NJ fire actually just had this out in Atlantic County part of our evacuations at a nursing home. It was neat a rig, but it took the staff of it around two hours to load it fully. I think having 12 regular BLS trucks would have gotten the job done quicker. Also with the tight compartments and staff number how can you really monitor the patients in transports?


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## JPINFV (Aug 30, 2011)

usafmedic45 said:


> Eh....honestly, I've always thought that the idea of a bus as an oversized ambulance was probably devised by someone who has never responded to a school bus accident.  For the cost of obtaining outfitting and maintaining one of these, you probably could purchase, stock and maintain in reserve quite a few BLS ambulances that would have much more utility in a "The sky is falling! The sky is falling" MCI.  With the hooks you find in most military ambulances, you can transport four litter patients in a standard box ambulance.  So much easier to drive especially in areas with marginal road infrastructure.




I think it's beneficial for disaster and special event situations where you need a fixed treatment post and MCIs where you can use it for the delays/walking wounded.


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## Bullets (Aug 30, 2011)

during Irene, that specific unit went to cape may county, mercer county and monmouth county on deployments. They evac'd 19 patients from a nursing home in cape may and transport them all over south jersey. In Mercer the did two full loads from another nursing home to a further inland facility. In monmouth the removed 143 patients to a local shelter while a river was literally flooding the parking lot 100ft away

Meanwhile, the boys from elizabeth ran almost 48hrs straight evacuating patient of a variety of long term facilities. Both departments have had their units for less then a month. In terms of usefulness, its its own strike team. Instead of assembling ambulances from multiple towns acoss a wide area. 4-6 emts can respond in this unit to any major emergency. 

they are also used primarily on fire rehabs. Instead of setting up tents with heating or AC that can take 30 minutes or more, this can open the doors and begin treating FF immediatley. 

This will not replace strike teams, and it shouldnt. But this allows those single resources to be utilized more effectively. thye can transport critical patients, reds and yellows, while the bus can handle the greens and whites

20 patients on stretchers, 24 in seats.


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## frdude1000 (Aug 30, 2011)

Here is a pic of the Medical Ambulance Bus for my county and the EMS Mass-Casualty Unit that trails behind it.


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## traumaluv2011 (Aug 31, 2011)

Bullets said:


> during Irene, that specific unit went to cape may county, mercer county and monmouth county on deployments. They evac'd 19 patients from a nursing home in cape may and transport them all over south jersey. In Mercer the did two full loads from another nursing home to a further inland facility. In monmouth the removed 143 patients to a local shelter while a river was literally flooding the parking lot 100ft away



Oh yea, I had a lot of fun evacuating elderly bedridden patients. We transported about 10 only to find out that the hospital was discharging all of them them after we dropped off the first seven. I guess because there wasn't a real medical emergency. So we brought them to a special shelter where nurses and a doctor were on location. We were out from 5 in the morning to about 4 in the afternoon. Just barely getting back before the hurricane started.

The worst part is that we only had one crew because they never toned out for any additional crews, which I think was stupid.


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## MrBrown (Aug 31, 2011)

We had one of those in the 1980s 

Transport of large number of green/walking wounded patients during an MCI can be handled by our Patient Transfer Service vehicles, they can hold like 8 or 10 people each


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## jjesusfreak01 (Sep 1, 2011)

My county has one of these, and I have been trained on it (everything but driving). Its primary purposes are to treat large amounts of walking wounded and to do mass evacs. It carries copious amounts of basic trauma supplies and every cot mount has O2 available, so its perfectly equipped for both of these functions.


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## mycrofft (Sep 1, 2011)

*Oh no. No nono no.*

Reminds me of the "busulances" used to carry pts from airlifts into air force hospitals.
A bus used as a bus is not for mass casualties, it is for either transporting large numbers of staff and supplies to a scene, or to give minimal pts a ride out like a, well, BUS.

Try this: the bus comes up (assuming a bus can get through), parks, disembarks a crew and some medical staff. They open the back, pull out and erect tents next to or connected to the bus. The bus acts as generator carrier, area lighting, air conditioning and heating, staff rest area, supply storage, and maybe transport for stabilized casualties once the hoorah has settled down. Tentage can increase available covered space fivefold.

MasCas _*treatment*_ needs lots of elbow room, ability to treat both sides of a pt (not just the side away from the wall), and ready access/egress for pts and litter crews. Not to mention lifting each pt up and down the height difference is bad.

I remember seeing a Lockheed ad many years ago, they were selling a C-130 Herc version which would land, taxi to the parking area, then basically "give birth" to an attached tentage facility which the Herc supplied with A/C, heat, electricity and commo.


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## Bullets (Sep 2, 2011)

And that is exactly how this can be used. it has 4 A/C units on the roof for cooling as well as baseboard heaters for warming up. The litters can be collapsed and seats fold down from the wall for seated pts or rehab. it has EZ-up tents underneath that can be set out and a ramp that extends from the back. So it can roll up to a fire or an event, put the ramp out, crank the AC and firefighters can go inside and rest and rehab before going back

It is NOT designed to be a unit that transports pts that require anything more then basic monitoring, anything above green should get its own ambulance. this is more for moving green patients to a handling facility nearby


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## mycrofft (Sep 2, 2011)

*Bullets thanks. This sounds more like crowd support than mass-cas.*

Some rejoinders:
"Possumbelly" busses can high-center on relatively small objects, or the lip of a downgrade (I've seen it done where a vehicle turned from a level city street down a descending turn into an alley and was STUCK like a turtle) and are not designed to operate off paved roads. Sound like primo firefighter rehab.  

The air conditioning, hot and cold, I'm talking about is projected into the tentage. (Heck, you could install filters and make it a postive pressure environment by sealing). 

I once had the opportunity to convert a 4WD USAF utility truck (read that "enclosed mobile mechanic shop on a shortened deuce and a half frame") into a medical field support vehicle to support up to 2,000 airmen during disaster deployments or field exercises. Many iterations were considered before it was decided that the cheaper, more-flexible and lower to the ground options in place made better sense, and they did. 

Historically I've been fascinated by these sorts of vehicles, but experience usually shows them to be vulnerable to physical and fiscal ills as well as sketchily conceived missions. 

Not that I'm not itching to get a look inside...


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## traumaluv2011 (Sep 2, 2011)

I agree with some of what you are saying. After looking at it in person, it does seem quite small inside. It is difficult to walk around the bus with other people, plus you have really bad access of the patient on the bottom bunk. I don't know how practical these things would be in a MCI, but there definitely is an easier way.


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## mycrofft (Sep 2, 2011)

*Fill the litter hooks with litters.*

Put 180 pounds or more of supplies and equipment on each litter and secure it.


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## LondonMedic (Sep 2, 2011)

Here's London's answer;




http://www.guardian.co.uk/society/2005/jul/07/hospitals.terrorism


(TL;DR, that's one of three buses that took casualties from the Aldgate scene to the Royal London Hossie on July 7th '05)


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## Bullets (Sep 2, 2011)

mycrofft said:


> Historically I've been fascinated by these sorts of vehicles, but experience usually shows them to be vulnerable to physical and fiscal ills as well as sketchily conceived missions.
> 
> Not that I'm not itching to get a look inside...[/FONT]



Speaking if ill concieved, i can talk about two missions during irene that we went on with this unit, one was right in its wheel house, the other was not.

The first was a request into south NJ to finish evacing a nursing home. 19 patients, all stable but most bed bound and with some level of dementia. These 19 patients had to go to 6 different facilities across south jersey. It took an hour to load all the patients onto to litters, along with staffing concerns. It took almost 12hrs to complete this mission, mostly because we had significant travel time between each facility, and we would only drop 2-3 pts at each place. 

Its actually not difficult to monitor the patients, we have welch-Allyn monitors for more serious patients, takes BP, Pulse, Oximetry, and 3-lead on a regular basis and stores all the info for later download, pretty simple stuff. Has a refrigerator on to keep water cold so thats nice for both passenger and crew. We take 4 EMTs, so one drives and the other 3 monitor.


The other deployment was an unannounced emergency evac from a low lying flood zone to a high ground area. We handled 143, mostly in wheelchairs. We can take 12 people in wheelchairs each trip and we only transported less then a mile. the facility also used a contracted agency to help the effort, along with local FD and OEM. Everything went smoothly and was an excellent mission only took 3 hrs to remove all the residents of the facility.


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## Tigger (Sep 3, 2011)

Bullets said:


> Speaking if ill concieved, i can talk about two missions during irene that we went on with this unit, one was right in its wheel house, the other was not.
> 
> The first was a request into south NJ to finish evacing a nursing home. 19 patients, all stable but most bed bound and with some level of dementia. These 19 patients had to go to 6 different facilities across south jersey. It took an hour to load all the patients onto to litters, along with staffing concerns. It took almost 12hrs to complete this mission, mostly because we had significant travel time between each facility, and we would only drop 2-3 pts at each place.
> 
> ...



I see what you have just described as the optimal purpose for these sort of units. Anyone thinking that transporting 20 patients that require continuous bedside monitoring is crazy. But for SNF evacuations I can't think of a better option. These patients need to be supine and that's about their only requirement besides maybe some 02. Anyone requiring more needs their own designated transport unit. 

I want my company to by one of these so we can knock out all the doctor appointment/dialysis visits for our "regular" patients at once. "All aboard the 845 shuttle to Davita Boston!"


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## Bullets (Sep 3, 2011)

Tigger said:


> I see what you have just described as the optimal purpose for these sort of units. Anyone thinking that transporting 20 patients that require continuous bedside monitoring is crazy. But for SNF evacuations I can't think of a better option. These patients need to be supine and that's about their only requirement besides maybe some 02. Anyone requiring more needs their own designated transport unit.
> 
> I want my company to by one of these so we can knock out all the doctor appointment/dialysis visits for our "regular" patients at once. "All aboard the 845 shuttle to Davita Boston!"


 Which is pretty much how these Irene events worked. Any patient that required direct medical oversight got a single resource.

Also, the bus has oxygen trees for every patient connected to an internal O2 supply system.


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## JJR512 (Sep 3, 2011)

Howard County, MD has a very similar unit.






http://keystonestatefirephotos.smug...rd-County/11778614_Gz5eA/5#1265035867_4cT592f


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## Bullets (Sep 4, 2011)

JJR512 said:


> Howard County, MD has a very similar unit.
> 
> 
> 
> ...



Not similar, th same, both units were made on thomas chasis by Sartin Services of High Point NC, along with Prince George, Lexington Ky, elizabeth and Jersey City NJ, and a few others, there are only like 20ish in existance


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## JJR512 (Sep 4, 2011)

Bullets said:


> Not similar, th same, both units were made on thomas chasis by Sartin Services of High Point NC, along with Prince George, Lexington Ky, elizabeth and Jersey City NJ, and a few others, there are only like 20ish in existance


 
I stand by my "similar" comment...Conceptually and functionally, yes, they are the same. The reason I said "similar" was that they appear to be from different years, or for whatever reason cosmetically (body, not paint) they are a bit different (the front end, grille area, headlights, etc.). Not a significant difference, true, and I was aware they were both from Sartin, but I just couldn't bring myself to call it the same when it looks different.


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