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St. Charles County Ambulance District trains to respond to mass casualty incidents

By: Brian Flinchpaugh


St. Charles County Ambulance District conduct training exercises in Wentzville in May. [Photo courtesy of SCCAD]

Even though only part of a training exercise, it’s a scene no one wants to see or experience. The question is what to do when, and if, it happens.

The “victims” are scattered around a school bus parking lot with obvious signs of injury – the aftermath of a fictional bus crash. The victims actually are mannequins or special volunteers decked out with bandages and fake blood stains, as school districts can be squeamish about students participating in graphic play-acting.

But it’s a scene that has played out for real in the past, most recently involving a Parkway School District bus crash on Interstate 44 this May involving 13 students.

Authorities are increasingly worried about a wide range of potential incidents that could prompt mass casualties. How well emergency responders – firefighters and ambulance district paramedics, in this case – react dictates how many people get prompt treatment and survive.

And that response requires training, fine-tuning and practice – something the St. Charles County Ambulance District has delved into deeply over the last several months.

The exercise was one of six mass casualty incident training exercises that occurred in May, involving about 500 emergency responders and held at a former bus parking area at the Wentzville School District administration center. Ambulance district officials expect to conduct similar exercises elsewhere in the county this year.

Rick Lane, training officer for the ambulance district, said they’ve been doing these exercises independently for over a decade.

According to Kyle Gaines, the district’s community relations director, the news of the day factors into their planning.

Scenarios can include shooting incidents, chemical leaks, fires, earthquakes, a terrorist attack or the aftermath of a tornado. It’s important that the training both be realistic and depict situations that have happened and could happen again. “If I have any reasonable involvement and engagement, I’ve got to make it plausible,” Lane said, explaining that an exercise involving spaceships coming down from Mars doesn’t count.

The key to responding to a mass casualty incident is adjusting emergency personnel’s everyday response.

“It’s such a different response demand for the paramedics than their typical call,” Lane said. “We’re asking the first responder to react to a situation where there are more patients than there are resources. And it changes everything when it happens.”

St. Charles County Ambulance District conduct training exercises in Wentzville in May. [Photo courtesy of SCCAD]

Mass casualty incidents can vary. Obviously, a large number of people hurt is a mass casualty incident, but even eight to 10 patients can tax immediate responder resources, Lane said. “It’s anytime the patients exceed the resources available on the scene,” he said.

Lane said paramedics have to become managers at the scene and “do the most good for the largest number of patients in the shortest period of time.”

Paramedics faced with large number of hurt people have to ration their resources and conduct what’s called triage – sorting their patients for priority transport and treatment based on the severity of their injuries, in the briefest period of time. Sometimes they have as little as one minute to make decisions about patients facing immediate life threats. It still can be a slow process; if there are 60 patients, that means at least an hour.

There also are often unforeseen variables on scene – it could be cold or raining or dark. One variable built into the Wentzville exercise was a patient who only spoke Spanish. Still, Lane sees responders and firefighters are up to the challenge.

“I always tell my first responders that I consider them the best problem-solvers there are. Every time they get an alarm, there is a problem to solve,” he said.

The training exercises are geared toward paramedics and fire departments, particularly some of the small departments in the county that don’t have as many full-time firefighters, Lane said. He said firefighters and paramedics often don’t train with police, whose responsibilities on the scene are different.

St. Charles County Ambulance District conduct training exercises in Wentzville in May. [Photo courtesy of SCCAD]

Lane asked teachers, principals and administrators who witnessed the Wentzville exercise what their role was on the scene. According to Lane, some staff members said they would drive to the scene to assist. That action is among the most dangerous things that they can do, because more parked vehicles and traffic could block ambulances and emergency vehicles.

If they do come to the scene, for example, to a bus accident, school officials should have basic information to share with responders, such as the number of students on the bus, their ages or if the bus was transporting students with special needs. That information sometimes can’t be gotten from a bus driver, who often is the most severely injured person in an accident, Lane said.

Gaines said another concern is having a group of parents show up at an incident searching for their children, which can turn into a mob scene and interfere with responders trying to help them.

Training, such as the recent mass casualty drill, help prepare emergency personnel to respond appropriately in all situations.

First responders in a training exercise

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