Univeristy Full Scale Exercise

[EAMstudent]

I'm a college, and I am majoring in Emergency Administration & Management. I am working as an intern in the campus' Emergency Operations Center, and my department/university is hosting on a full scale exercise that involves the County EMS, city fire department & police, and the regional hospitals to meet their exercise requirements for state training requirements and grant requirements. As an intern I have been assigned the task of writing the victim scenarios. We are going to have several victims as a result as a simulated Improvised Explosive Device (IED) at the campus cafeteria at noon time. We are only transporting a limited number of the victims to the hospitals. I need a little help with gauging realistic Blood Pressure, Heart Rates, and the possibility for any other additional information you can supply me with for a few of the victims we are transporting.

Here are the victims injuries:

Amputated left arm- no limb found
BP:??
HR:??
Other:??

C- spine injury
BP:??
HR:??
Other:??

Pipe or post impaled in abdomen
BP:??
HR:??
Other:??

Pregnant- 7 month gestation- no bleeding- Gr1
BP:??
HR:??
Other:??

Burn 2nd degree and 3rd degree- 60% BSA
BP:??
HR:??
Other:??

Sucking chest wound
BP:??
HR:??
Other:??

Open head injuries with GCS of 5
BP:??
HR:??
Other:??

Severe respitory distress
BP:??
HR:??
Other:??

Thank you for any help that you can provide me with.

 

[Ridryder911]

I always find that nearly all incident scenarios have the same routine injuries, no matter what the occurring incident may be. So I will give you the same routine v.s. that is found with nearly all scenarios. Albeit, I do not know what the "occurrence or incident" is.

Amputated left arm- no limb found
BP:8040
HR:120
Other: resp rate 14 shallow, < LOC

C- spine injury
BP:90/50
HR:96
Other:R/r 14 diaphragmatic

Pipe or post impaled in abdomen
BP:60/40
HR:130
Other: Somnolent, < LOC

Pregnant- 7 month gestation- no bleeding- Gr1
BP:124/64
HR:96
Other:??

Burn 2nd degree and 3rd degree- 60% BSA
BP:100/60
HR:100
Other: 14

Sucking chest wound
BP:60/40
HR:128
Other:r/R 8

Open head injuries with GCS of 5
BP:140/100
HR:40
Other:r/R 8

Severe respiratory distress
BP:110/64
HR:134
Other: R/r 28


Since you are a student and are learning, be aware of this. This is why MCI drills are routinely considered a "joke" and not taken very seriously from those whom participate in them, other than administration "patting themselves on the back".

I have personally been involved in some of the major MCI in the nation. I will tell you a lot of what we teach and practice, goes out the window. The first problem you will notice is the lack of ability of communications, and as well interactions.

Restricting the number of patients being transported is one of the first mistakes made in drills. In real life, minor patients hit the door of the ER, way before any before the major trauma patients arrive. ER always assume they can handle the "number", especially when they can walk through patients.
Unrealistic time and staff is assumed that they can handle the load.

I do ask as well, if in this drill you considered water, sewer, public utilities that many miss as well. Security to the areas of the hospital and if and how they would handle the entourage of press, immediate family and on-lookers.

Good luck in your studies and drill.
R/r 911

 

[Jon]

Ok... I'll make easy calls for a couple of easy ones... but I yield to most others on this board if they contradict me.

Amputated left arm- no limb found
BP:??
HR:??
Other:??

This can be played as an obvious case of shock... note that the skin is pale and cool (decreased circulation).
B/P should be less than 100 systolic... say 76/50.
Pulse should be high - say 120-140
Note what the level of blood is coming out of the wound.. if it's stopped already, vs. if it is still profusely bleeding.
Mental status - can be played with the patient either conscious or unconscious... conscious... this patient should be moderatly confused and not always responding appropriatly to questions. Perhaps the patient dosen't really feel pain, but is repeating "my arm, my arm"

Pipe or post impaled in abdomen
BP:??
HR:??
Other:??

Again... easiset way to play it is that it is an obvious case of shock... pale, cool skin.
B/P - again, shocky, so systolic should be below 100. How about 84/60?
Pulse should be high - say 140.
Mental status - can be played with the patient either conscious or unconscious... conscious... this patient should be moderatly confused and not always responding appropriatly to questions. Further, this patient could be in extreme pain.


~Edit~

To continue with Rid's thoughts... why not bus a bunch of students to the front door of the ED saying "they can't hear" and "I got blood on me.... I think I've got AIDS!" and be a bunch of panicky young adults... this will account for the "walking wounded" that self-refer to the hospital.

 

[EAMstudent]

Thank you for your help.

We actually have taken into account walking wounded coming into the ER before and after EMS has transported the major trauma victims to the hospital. We are having a group of students that are playing the part of the walking wounded. One of the purpose of this exercise, from the hospital standpoint, is for us to overwhelm them with not only the number, but with there capabilities to handle certain types of victims. In overwhelming the local hospital, the hospital is going to be forced to contact other hospitals in the region and the state health department. Then they have to decide when they can take no more victims and then where to send them based on their injuries. The majority of the agencies players, with the exception of their supervisors, have been kept in the dark as to the nature of this exercise; so they have no idea if they can handle the scenario.

As far as the public utilities, that is part of what the university is testing itself on. Without power, water, sewer, etc. they will not be able to house the 3000 some odd students that reside on campus; so the university officials will have to decide what to do with all the students till all of these things are functioning again. Another aspect they will have to consider, since this incident is at the cafeteria they will have to decide how they are going to feed all of these students.

We have also taken into account a large entourage of press and family members of the students involved. This will be handled by volunteers from the journalism dept. for the press and then phone calls from family members will come from a SIM Cell.

If you have anymore ideas or helpful info dont hesitate to post it.

 

[Ridryder911]

Sounds like a better planed drill than most. American College of Emergency Physicians has an outstanding workbook that I highly recommend on establishing a disaster plan. Especially those that work in a hospital environment, from water to flush the toilets to handling of the press, etc.

The most important part of a drill is to really find and adress the weak points. Many will give kudos and compliments, but fail to do what the drill purpose was for... identifying strengths and weaknesses. Place a plan to correct those items that can be corrected and at least acknowledge those that cannot ( it is okay, to do so) or ever will be able to corrected.

Glad to see true educated personal entering this area and field. It has been long over do.

R/r 911