Thursday, October 5, 2017

Mass Casualty Incidents and Triage

By: Sebastian Berry

Friends of Family Survival Farm: It is with a heavy heart and after much pondering that I make this posting. I make a pretty good effort to make my posts timely and relevant. Like posting about fireworks and burns around the 4th of July. I feel this one will be more difficult due to the tender nature of recent events in Las Vegas.

On October 1, 2017 a man opened fire on unsuspecting concert goers in an adjacent location across the road from the Mandalay Bay Hotel and Casino. He killed at least 58 and injured almost another 500. Fox News Timeline of Events. I have neither the inclination to mention the shooters name or to delve into a second amendment argument. This act was senseless and seemingly unprovoked and the loss of life saddens me deeply.

DISCLAIMER: Instructions and information here is not a substitute for professional medical care and treatment. If you are having an emergency call 911 or your local emergency number for assistance.

I do not claim credit to any of the images used unless specifically indicated. All rights and credits remain with the original owners

Let me be very clear from the start, people die. This is an unfortunate fact of life. All of us have or will lose people that we love, care for, or are close to. Sometimes, bad things happen to very good people. Many times there is just simply nothing we can do about it.


Good people died in Las Vegas last Sunday. Other good people did all they could to save them. It is not a very difficult Google search to find the stories of heroism that took place. People covering people to shield them from fire. We've all heard the story of the man that commandeered a truck to take people to the hospital. And then there's this...


Mass Casualty Incidents or MCI, overwhelm medical systems and emergency responders. I work at a hospital under a company called HCA. The company CEO, Milton Johnson, sent an email to all employees about the shooting. Here's a little glimpse.
"...As the horrific details of the Route 91 shooting in Las Vegas became evident, we also learned of the incredible impact it had on our colleagues at Sunrise Hospital and Medical Center and its sister hospitals, Southern Hills Hospital and Mountain View Hospital.  Even though our hospitals regularly plan for mass casualties, no one could have anticipated the magnitude of this tragic event. 
As the closest trauma center to the concert site, Sunrise immediately started receiving patients that arrived by all modes of transportation.  Ultimately, they would care for approximately two hundred victims.  For the entirety of the event, one hundred twenty patients with gunshot wounds received care.  All 30 operating rooms were immediately activated and operated throughout the night and following day.  In all, more than 80 operations were performed..."
People and equipment from those sister hospitals was transferred to help effect the care of the injured. It is no small feat to go from normal operations to bursting at the seams and still handling more.

Dr. James Sebesta is a retired Army Colonel and surgeon who was in attendance at the concert.


 He recalls in a newspaper interview with The Seattle Times:
...He recalls one man, assisted by his son, who had a bullet wound in his back. He helped to carry the man off the field but doesn’t know if he survived.
Another woman he came upon was grievously wounded, and he knew she could not be saved. So he moved on.
“We went from person to person trying to get the people who were still alive out of there, and then went back after that and got some of the people who had expired, “ Sebesta recalled.
Eventually, he reunited with his wife, Janelle, at their hotel after 3 a.m. Monday. He could not sleep as his wife’s phone kept “blowing up” with messages from family and friends.
“I’ve been in the Army a long time. I’ve been to war four or five times … I’ve been in a lot of bad places during my career and seen lots of mass cal (casualty) things. But in the Army, we were ready for ’em. And the other thing is, there was a reason for it — I mean, it was war,”...
Herein lies the hard part of MCI and triage. We must determine quickly those who our help can help the most. We must make a decision on the fly if people stand a reasonable chance of being saved. In one of my previous articles on first aid (you can read it here) I wrote:
"There are two questions a person must ask themselves before rendering aid...
    1. Do I have the skills to render proper aid?
    2. Do I have the equipment to render proper aid?
If either question is answered no, then you must seriously reconsider rendering aid."
In MCI's this traditional thinking goes out the window. In MCI's if you have hands and are able to function you can be put to work. Like Colonel Sebesta recalled in being able to get people out of the danger area and to treatment. YOU might be the one to have to move people or to put your fingers into the bleeding hole in order to stop the bleeding. In another article I wrote about tourniquets (here), that might be the only thing that keeps a person from bleeding to death and you might be the only person available to apply one.

Triage, typically, functions with the following labels for groups.

  • GREEN: Uninjured or very lightly injured (think band-aids and bruises)
    • These are the people that can be put to work.
  • YELLOW: Walking wounded or folks to be considered for URGENT care.
    • These people typically are able to follow simple one step commands and need assistance in moving.
  • RED: These are your gunshot wounds, stab wounds, or long bone fractures like the legs or upper arms. URGENT SURGICAL.
    • These injuries require immediate and possibly life saving interventions.
  • BLACK: Also known as EXPECTANT or dead or actively dying.
    • These are people who are not breathing or responsive on initial encounter, the airway is opened and if they do not breathe spontaneously are to be considered dead and no further aid rendered.
    • Extensive burns, especially those that involve the respiratory tract.
    • Obvious wounds not compatible with life, like open skull fractures with visible gray matter.
In the world that we live in now. Anyone might be called on to perform triage. Like I have told my friends and family- Head on a swivel. As our government has told us- If you see something, say something. It only takes a moment for our world to change.

We must be prepared. Do you have specific plans for MCI? Talk to us in the comments. Please don't forget to check out our giveaway section here.