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In the face of disaster: Emergency responders practice ‘getting it right’

LaFaye Young [center] was one of the volunteers posing as a victim in the county’s mass casualty incident training exercises

LaFaye Young really didn’t have many lines for the part she was playing. Her “costume” was a straw hat. The “infant” she clutched close to her was hard plastic.

But her admirers said her role didn’t require any dialog. Young was portraying the “non-English-speaking patient” at a Mass Casualty Incident [MCI] exercise in early May for St. Charles County firefighters and paramedics. As such, her goal was getting the attitude right.

That attitude was on display at the exercise on the grounds of St. Charles Community College’s School of Nursing and Allied Health in Dardenne Prairie.

Organized by the St. Charles County Ambulance District [SCCAD], the exercise provided training for county paramedics and firefighters dealing with a chlorine leak. That training not only encompasses the leak but other details such as what emergency providers sometimes confront when dealing with disaster victims. When a fireman or paramedic approached Young to try to help her, she waved an arm and squawked an indecipherable protest, clinging to the plastic infant.

It’s one of a cadre of disaster victims Young has portrayed over the years as a volunteer victim at disaster preparation drills said Kim McKenna, SCCAD’s education director. “She’s a great actress,” McKenna said.

Nailing the part right is important because practice makes perfect for emergency providers who have to get it right when the real thing happens. That’s what guides Young, who is “70-plus” and, since 2003, has been a volunteer with the Community Emergency Response Team [CERT].

“It’s because the better we train our firefighters and paramedics, the better our service is going to be,” Young said.

The annual MCI training sessions and live exercises were held throughout May. No fumes or chemicals are released as part of the exercise but, despite that concession, firefighters and paramedics tried to keep things as real as possible, according to Kyle Gaines, SCCAD’s community relations director. The purpose is to allow firefighters and paramedics to work together to apply critical thinking skills and training as they deal with chemical hazards and remove victims from an unsafe environment, possibly decontaminating them and transporting them to medical attention based on their injuries. It’s not a simple process.

Mimicking real life

Emergency providers have to consider a complicated number of details in MCI situations: how they have to be organized, who is in charge, what process to follow, how to allocate patients to hospitals and how to identify the leaking chemical or chemicals. Getting into places where traditional equipment will not go is another consideration. During the morning exercise, the first of two on May 11, the first responders were using small utility terrain vehicles to remove victims from an area where ambulances and fire trucks would have a hard time reaching.

Having an exercise outdoors also introduces other variables that have to be taken into account. “There’s a pretty decent little breeze out here today. That changes things,” Gaines said. “We might be assigning people to go door-to-door in this neighborhood right over here to your left” to warn them of any anticipated “danger” and to check for “victims.”

Residents of the nearby Barathaven subdivision were notified about the exercise.

Although the scenario for the exercise was planned well in advance, the selection of chlorine as the chemical agent involved became timely following the April 7 chemical attack in Douma, Syria. Chlorine and the nerve agent sarin were believed to have been used in the attack that left more than 40 dead.

Exposure to concentrated levels of chlorine gas can lead to fluid build-up in the lungs, known as a pulmonary edema. Symptoms of exposure include wheezing, labored breathing, sore throat and chest tightness.

Gaines said that, in each of the last three years, something has happened in the world that closely has mimicked what the planned MCI scenarios covered. “This year we already had this plan and Syria happened. Last year, we already had this bus plan and then, in Kirkwood, we had a school bus go off the road, thankfully with no serious injuries,” he said. “It just highlights to everyone involved that these things can happen and they do and it’s important that we’re ready for them.”

It’s not only terrorism but natural events or accidents that can pose problems, Gaines said. He noted a fire in May involving a fuel truck with highly flammable ethanol that burned at Interstate 70 and Mid Rivers Mall Drive. “We dodged a bullet there,” he said.

There is a lot of industry here and there are some obvious concerns there, he said. “But most of those areas are on top of their safety and security, and we don’t see a lot of incidents,” said SCCAD Deputy Chief Jeremey Hollrah.

In real time

The two-hour exercise began at about 9 a.m. on a parking lot near the school’s gymnasium. There, firemen and paramedics were briefed on their roles. “The most important thing today is safety,” SCCAD Training Officer Rick Lane, who heads the MCI exercise each year, told those involved. “No one gets hurt.”

The planned chlorine leak scenario began to unfold when fire trucks from the Wentzville and Central County fire protection districts arrived responding to, in theory, a “chlorine tank leak at a swimming pool with a festival going on nearby with a lot of people affected.”

Hollrah said firemen, with gas masks and other equipment, arrive on the scene and go into the affected area to assess the situation. They are followed by paramedics who begin to triage patients – determining the priority of care – and start bringing them out for decontamination or possible transport to hospitals. Decontamination is achieved by using water sprayed from a fire hose hung from a ladder truck.

In all about 30 firemen and paramedics were involved in the May 11 practice session. Throughout May, roughly 500 firemen from eight county fire protection districts and other SCCAD personnel participated in the drills.

The victims are a mix of mostly damaged mannequins who had seen better days, some missing a leg or two, and live volunteers, such as Young, sitting or lying on the athletic field behind the gymnasium.

During triage, ambulance crews went from victim to victim, sometimes writing medical information on pieces of paper and pinning them to the victims’ clothing or writing the information directly onto their clothing. Colored ribbons, tied to an arm or leg, also helped to identify the severity of a person’s injury – yellow for less severe and red for life-threatening.

Crews using the all-terrain vehicles picked up patients and transported them to a central location where they were further evaluated.

Nate Campana, 22, was one of a handful of paramedic students playing the part of a disaster victim. He lay on his back awaiting transport, his white T-shirt a canvas of written instructions.

He has three months to go before completing his courses but playing victim has given him a unique perspective, he said.

“Seeing an MCI for the first time is interesting, especially when you’re going through class,” Campana said. “I’ve been watching what people do and putting that together with what we have learned in class and what we’re doing today.”

With an audience of experts

There were also other observers. Watching were three physicians from Washington University. Two of them, Sven Steen and Melissa Kroll, were part of the university’s EMS one-year fellowship program. Bridgette Svancarek, is a board-certified emergency medicine physician and instructor at Washington University’s Medical School.

McKenna said the physicians are raising the bar for physician involvement in EMS programs. They are physicians who may become medical directors for EMS providers, he said.

In the past, McKenna said EMS medical director training wasn’t given a high priority. “They didn’t necessarily understand our world,” he said. That has changed.

“These folks are up-to-date on the research related to EMS specifically,” McKenna said. “They’ve gone on ambulance calls so they know how that flow, that choreography is very different than normally what an ER would be like. They understand the challenges we face.”

Svarncarek said the role of ER physicians has changed over the past 10 to 20 years. “It used to be that the EMS providers would never even see their medical director or even know who their medical director is,” Svarncarek said. “The medical director would simply sign off on protocols.

“But the role of EMS physicians, and this is throughout the country, is to work side-by-side with EMS providers from the very beginning of their training and throughout their career.”

To that end, Svarncarek said SCCAD does a great job with its training exercises.

“One of the best things about a fellowship is you get the opportunity to show up at two events like this,” Kroll said. “Instead of reading a story and picking an answer in a test, you get actually see what the challenges are and sometimes those challenges are unexpected.”

Because practice makes perfect

The morning exercise on May 11 ended back at the parking lot in front of the gym with fire and ambulance district heads and participants taking a water break and critiquing the exercise. It received high marks. Among the topics of discussion was the flow of radio dispatching and traffic, a vital task because sending too many patients to one hospital can swamp that emergency department.

“We do this kind of stuff every day just not to this scale. We run calls, we run calls, we run calls, it’s what we do,” Hollrah said.

The all-terrain vehicles got great reviews for being able to be driven into areas that ambulances and fire department vehicles cannot reach. “Get familiar with these things,” Lane advised. “These are great vehicles for a wide area of rescue like this.”

During the break, the students sat back with some doing a quick search for unwelcome guests – ticks – that might have crawled on them as they were laying in the athletic field’s grass. Young had finally put down her plastic infant but not before giving a paramedic or two a sampling of her harsh “non-English speaking” persona. She plans to continue to volunteer.

“They [emergency responders] need to practice, over and over and over again,” she said.

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