Monthly Archives: September 2014

The Importance of Being Prepared

Earlier this month, I participated in Mammoth Medical Missions three-day Mass Casualty Seminar. Below is the feature article I wrote about my experience that appeared in the September 18 issue of the Mammoth Times

Blood spurted from the femoral artery of our first victim as I applied pressure and Katie Dease tightened the tourniquet on his upper thigh. Our team leader, third-year medical student Jayce Porter, had already established an airway and was inserting a second chest tube. In the aftermath of the 6.8 magnitude earthquake that had rocked Mono County moments before, we knew this was just the beginning.

We’d barely stabilized the first patient when the lights went out in the operating room and our second casualty arrived. He’d sustained crush injuries to his lower torso, including a broken pelvis, and he wasn’t breathing. Katie and I bound the victim’s pelvis by the light of our headlamps with the only thing we could find—a surgical gown—while Jayce once again worked to restore breathing.

The noise swelled in volume. The smoke was so thick we could barely see those working a few feet away. Friends and family members clamored for information about their loved ones, adding to the chaos. And then the team leader at one of the other operating tables suffered a mental breakdown and fell to the floor, taking an entire tray of surgical instruments with him.

Forty-five minutes after the first victims had reached the operating room, the lights flicked on, the screeching stopped, and Dr. Mike Karch called time on the mass casualty simulation drill that capped the three-day seminar put on by Mammoth Medical Missions. Still breathing hard, I glanced at the watery red puddle under the operating table and wondered if a real victim would have survived our fumbles with the tourniquet. As I dropped my mask, someone threw the doors of the cadaver trailer open to let the smoke out.

I wasn’t sure exactly what I was in for when I signed up for the third annual Mammoth Mass Casualty Seminar, which was held at Eagle Lodge, September 10-12. Because medical and emergency services personnel receive continuing education credits for the program, I knew most of the participants would probably fall into one of those two categories. But I figured I could learn something valuable, even if a lot of the material went over my head.

We spent the first day listening to a fast-paced series of lectures on topics ranging from the innovations in military medicine and how they’re impacting civilian mass casualty treatment to the legal ramifications of rescue under California law. Some of the medical jargon eluded me, but in general the material was very accessible, even to someone lacking formal training.

Best takeaways from that first day? I loved the light, flexible Goal Zero solar panels Scott McGuire showed us, and Dr. Sierra Bourne’s nugget about treating infected wounds with honey (ideally medical grade, but in a pinch you can use what you’ve got in the kitchen) in the absence of antibiotics was a real revelation.

On day two, we began putting into practice what we’d learned in the lectures. In small groups, with multiple instructors per group, we rotated through seven stations where we worked on skill sets critical in a mass casualty situation. My group started outside with the basics of setting up a field hospital, complete with operating room, in an austere environment. Next we moved into the cadaver lab, where we practiced our ABCs, assessing and treating issues with Airway, Breathing, and Circulation, on the amazing Worldpoint Cut Suit. No one was allowed to be a shrinking violet—I took my turn inserting breathing and chest tubes alongside the doctors and nurses in my group.

Down the line, as we prepared to treat compartment syndrome on a cadaver, Dr. Richard Brown polled the group in regard to their medical expertise. When I admitted I had none, he slapped the scalpel in my hand and said, “You’re up first.” And yeah, I sliced a little deep the first time, mainly because other than accidentally cutting myself with a kitchen knife, I‘d never applied a blade to human skin before. But I learned, and in an extreme situation I now know I could perform the procedure if I had to.

On the final day of the seminar, the rubber really met the road. Participants were divided into three teams, and we cycled through three one-hour simulations while the instructors critiqued our performance.

Our team began by constructing a fully operational field hospital from scrap lumber, while simultaneously maintaining order in the distraught “crowd” clamoring for immediate treatment.

In our second rotation, we performed triage and treatment on a group of earthquake “victims” that included civilians, as well as Forest Service personnel. All of them delivered very vocal, Oscar-worthy performances.

And then it was our turn to experience the chaos of the cadaver trailer. Early in the seminar, Dr. Karch mentioned that simulations like the one I described at the beginning of this article have been shown to raise alpha-amylase levels in participants’ saliva just as real-life traumatic events do. Based on my own reactions, I have no trouble believing those findings.

Several people asked why I’d chosen to spend three days immersing myself in the nitty-gritty of dealing with a mass casualty scenario. The obvious answer—at least it’s obvious to me—is that as many of us as possible need to be prepared for such a situation.

We live in a relatively remote area with one way in and one way out. Given our location, earthquakes top the list of disasters we’re likely to experience, but wildfires, airplane or bus crashes, and school shootings are also distinct possibilities.

Few of us want to dwell on these horrific scenarios. But thinking them through and acting them out actually lessened my anxiety because I feel more confident about my ability to cope with such a situation. Next year’s Mammoth Mass Casualty Seminar is scheduled for September 24-26. I can’t think of a more important way to spend three days.