# Mass Casualty Triage Scenario?



## keith10247

Good Afternoon all.  I was doing some thinking and have decided to setup a mass casualty drill for my station.  I need help coming up with a scenario for this exercise.  

I was thinking about possibly doing an isolated hazmat related incident where there was an outdoor exposure during an outdoor event.  Was thinking that I could get 15 or so patients.  This would offer the utilization of PPE, Hazmat awareness, and triage.  

We are a combined fire and rescue squad and we have recently had at least 20 new members join within the past 5 months or so.  They have yet to be exposed to this kind of training.  


Thoughts?


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## TheAfterAffect

The best scenario you can probably do is a Cleaning incident in a large kitchen at an event or something. 

Where someone accidentally mixes bleach and Clorox together, thereby forming Chlorine Gas. Hazmat, PPE, and triage could be on the severity of their poisoning.


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## traumateam1

You could do a Greyhound bus vs. 18 wheeler or train situation? Or as TheAfterAffect said you could do a HazMat situation as well.


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## Jon

Also... if you need victims... look to the local Boy Scouts. If you work with them, they can get credit for the Emergency Prep merit badge.


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## TheAfterAffect

Jon said:


> Also... if you need victims... look to the local Boy Scouts. If you work with them, they can get credit for the Emergency Prep merit badge.




Not trying to put the boy scouts down but also look towards the Civil Air Patrol. Cadets in CAP and SMs also are used to working on MCI's as they are required to have training in ICS and NIMS for certain achievements.


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## mycrofft

*Many schools have community service points or drama depts.*

Plan it backwards:
1. What exactly do you want the attendees to come away with? Specifically. As in you can describe it other than "an increased awareness" or "Optimization of...". Keep it simple the first time out. How will you know they "got it"? (Pre and post event quiz).

2. What will provide this experience with the least effort planning money etc? (Makes it more likely to occur without a hitch). Match this to your solid resources.

If the scnario can be "reset" readily, you can run a simple one mutiple times to try for better performance, or changing roles, or changing approaches. 

Have some "proctors", "safety monitors" or some such. Sit down and plan with them the night before, then do a post-event with them.

If you use volunteer victims and helpers you have to treat them right not only to make your event work, but to not turn them off to coming to any future events. Bathrooms, refreshments, rides, parking, something to make it fun/ice breakers, door prize or something, clearcut but gently applied rules about bringing kids and pets, lunch. Break area/shelter, and real world first aid separate from the scenario. Cleanup crew! (important, everyone wants to boogey away after).

Write an unflinching afteraction report. Goal, description of event, who furnished what support, what support you furnished, quantifible results, area for imporvement, whether it met or failed the expectations, and discussion ("for next time"). Be sure to thank people, and "thank them to their boss", too!

PS: MOULAGE: believe it or not, highly overrated versus the cost effort and cleanup. It can never be "as real as real", although better than rubber strapons. Teach diagnosis separately. If you DO moulage, make sure the cleanup process is gentle on the victims.


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## mycrofft

*PS; google "CERT LA" go to their "Ideas" area and look up "training"*

,,,,,,,,


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## Jeremy89

Not to get the forum off track, but I was thinking about MCI's a couple weeks ago (particularly around 9/11).  Can you imagine the insane triage that went on in Manhattan that day??

Oh, and AfterAffect, I think he was talking about using boy scouts for victims, not providers.  Not sure though.


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## TheAfterAffect

Jeremy89 said:


> Oh, and AfterAffect, I think he was talking about using boy scouts for victims, not providers.  Not sure though.




I was talking about for both Also 


Not to get off track again, Im part of the CAP and I try my hardest to get the organization known. Its a great organization similar to the Boy Scouts but Military Oriented.


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## phunguy

We had an MCI at our local sports arena tuesday night where they simulated an airplane crashing into it. We used past and present EMT students from the local college as victims.


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## mycrofft

*MassCas from WTC: nowhere near as bad as it could have been.*

There's a planning aspect, severity of incident and time elapsed perform their own triage. Make em die after a while, sound an air horn every five minutes and some victims die each time if not "stabilized" yet.

Triage that day was simplified in that the thousands of people in the buildings were killed outright. It was, I have read, hairy, but far better than if the buildings had just burned versus collapsed.


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## johnrsemt

Mass Cas scenario:

   High school or College  open football stadium that gets sprayed with an unknown liquid from a crop duster.       

   anywhere upto 50,000 people in mass hysteria;   injuries from the panicked stampede of people leaving the stadium;     chest pain from panic;  difficulty breathing from people running who shouldn't be.

   Go with that,  could get real ugly in a real life situation,  and easy for someone to do.


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## EMT-P633

A very real MCI that hit home to me happened today to my sister.

A bit of history is needed first.  My oldest sister is an EMT-I in the state of Indiana. she works for a small rual community 911 service. She and her husband have 10 children. one of which is a special needs, we will call her Abby, My sister was off work today and got paged out for a first responder to a semi/dump truck vrs school bus at 1530 hours.  

Yes it was my niece's special needs bus.
No my niece was not on the bus. She was dropped off at home at approx 1500 hours.
Yes, there were fatalities. 4 children.

My sister called me around 8 PM crying and very upset, which is totally understandable. Her and I have always had a special bond growing up. we both served in the military, fire departments. and now EMS.


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## CPG

TheAfterAffect said:


> I was talking about for both Also
> 
> 
> Not to get off track again, Im part of the CAP and I try my hardest to get the organization known. Its a great organization similar to the Boy Scouts but Military Oriented.



Capt McLaughlin
Deputy Commander
NCR-IA-072


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## csly27

When I graduated my cert training our scenario was a 5.8 eathquake. We used other cert members and the young marins for aour victoms. Plenty of hazmat things could be involved with major earthquake as well as mass causaultys. Good luck.


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## mycrofft

*So, ketih10247, how did/is it go (ing)?*

10characters


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## keith10247

Hey mycroft, I have had to put it on the back burner for a little bit.  I am going through a job transition and we are also getting ready for our yearly burn for the fire side of the house...  I need to get it done soon before it becomes 10 degrees outside and we are triaging in the snow.  

I must admit, it has slightly slipped my mind...   Thanks for the reminder!


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## keith10247

I totally forgot, I did do a quick draft of a scenario a little bit ago... (It is 2:43am and I am still at work...time for bed I think!)

Let me know what your thoughts are.

Here is what I have come up with so far:

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*Scenario:  *
Amtrak vs. Amtrak – 2 Amtrak passenger trains collide causing derailment.  

*Scenario Scene configuration:*
- Outdoors in a large parking lot.  
- 15-20 patients in 2 clusters. 

*Initial Patient Classifications:*
- 5 Black
- 8 Red
- 4 Yellow
- 3 Green

*Reassessed Patients:*
- 1 Red Downgraded to Black  (Final Total: 6) 
- 2 Red Upgraded to Yellow (Final Total: 7)
- 2 Yellow Downgrade to Red  (Final Total: 3)
- 1 Yellow Upgrade to Green  (Final Total: 4)

*Minimum Needed Positions:*
- Incident commander 
- Transportation commander
- Sector leads
- Initial Triagers (New/Precepting EMS Leads?)
- Ambulance crew 
- Rescue/Engine crew
- Manpower

*Key Points:*
- Initial scene size-up
- Identify hazards
- Identify resource needs
- First in unit establishing command (Prior to Battalion Chief Arrival)
- Assembly of crews
- Personnel allocation and accountability
- Assembly of different sectors
- Scene safety and control
- Patient assessment
- Wound care and packaging
- Preparing for transport


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## keith10247

*Moulage...*

So from the aspect of Moulaging patients...From what I have been told (and it totally makes sense) the kids find it to be really cool to be moulaged...  Who doesn't want to have a giant avulsion that doesn't hurt?  :-D

We will most likely be moulaging (we have the moulage kits that rarely, if ever, get used..)


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## Sapphyre

Keith, 
Your plan looks good to me (but, what do I know, never wrote an ops plan for anything before).

One question, and an accompanying comment.  Where are you located?  I ask this, because, well, you're Amtrak versus Amtrak could be perceived as being really close to the Metrolink (commuter train) versus Union Pacific (freight) crash we had out here in California recently.


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## mycrofft

*If you have to wave off, do SOMETHING for your "willings"*

As in they were willing to come out and help. Use the money for the thank yo" BBQ or whatever for a party or whatever?
How about a quick shift mentally to plan B...say, a panic INDOORS at a rave party in a willing owner's building (school gym? FD barn with trucks pulled out?) with only two doors open, two clusters of victims...


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## csly27

I just have a quick ? I thought when you were triaging people you were not supposed to down grade. they were obviously upgraded for a reason usually being serious therefore you could only upgrade not downgrade.


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## keith10247

Sapphyre, I am located in Northern VA (Outside of DC).  I chose Amtrak because we  have them out here and I used to be a consultant assigned to them.

Thanks for your feedback!


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## keith10247

I am sure there wont be an issue with getting people who are willing... It just becomes more exciting to be all dolled up with lacerations and avulsions.  

I will definitely take the indoor scenario in to mind (maybe write up 2 separate scenarios and depending on the weather or crew turnout, we can choose which one to exercise).  In all reality, the only person who is really supposed to know the scenario is the training coordinator...  I was wanting to keep something outdoors so that the people who are doing command (our chief) can see all that is going on and that people can run to units to get supplies.  

I just noticed that I totally forgot a rehab sector.  Minor detail but critical, IMHO.


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## mycrofft

*CSLY he means they are getting worse with elapsed time.*

The caregivers want to upgrade their condition, tiome and the referee want it to get worse unless it is treated or it is inevitable.


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## keith10247

csly, To be honest, I have only done one triage simulation; my EMT class did not heavily stress on it for some reason.  

My understanding is that poor judgement on the triager (not sure if that is an actual word) could cause a deterioration of the patient.  My hope is that another triager will be involved with the reassessment and catch things that the initial triage did not pickup.  In the heat of the moment, someone might be classified as a Yellow patient but then over time you could come across the whole "oh *@#& dude is gonna die!" and have him downgraded to a red severity.  It could also be a case where a Yellow's vitals stabilize to where they can be treated with a less urgent severity.  

As we know, the human body is not very predictable... just because a patient was once thought of as a medium priority, doesn't mean he should be treated with medium priority if he needs more urgent care.  

I may be wrong, so please correct me if I am.


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## mycrofft

*IN ther real world that will happen a lot.*

Mass Cas triageurs will by the definition of the situation have pts slip to lower categories and die. They don't teach that and if/when it happens it may make the triageur give up, freeze, or frenzy.


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