# Boston Marathon - MCI - EMT/Medics/First Responders



## Dakine (Sep 4, 2012)

I'm hoping to keep this separate from the thread in the International News forum, I'll understand if mods merge, but I hope that wont be necessary as I want to keep this focused on everything from a professional health care and/or first responder point of view, the current event is just a reason to ask, not the subject, its only context... 

A) The event
B) The triage
C) Patient Care
D) The EMS kicking into gear as new resources are brought in
E) CISD (critical incident stress debriefing)


It's extremely unlikely I'll have the chance to go to medic school, I'm done with EMT school but I'm a little long in the tooth to start over and try to get on a FD at my age (even worse projected 3-5 years down the road when I'd actually be hired after completing medic school, fire academy, etc)

So what are the thoughts of FR/EMT/EMT-P on the situation immediately following detonation of the devices?

I know priority 1 is SS/BSI and since it's most definitely suspicious of terror attack, the thing to watch for is secondary devices to kill/wound the responders.

whats next? what can I learn here to bring forward as an EMT in my local CERT, heaven forbid this happen again!? Obviously massive gnarly terror attacks are not all that common, but a tornado will really put a dent into a small town, a hurricane will make a mess out of the scene and overwhelm EMS... so that's what I'm hoping to learn from people in the field!

Thanks!!!
Dak


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## nopolitics12 (Mar 20, 2013)

As a former first responder and CERT member I can tell you that experience is the only way you'll know what to do better the next go-round. Sure, practicals help, but until you have a patient with a hairline fracture of one of the neck vertebra or one with a massive bleed all you can really do is psych yourself up for the possibilities. In short, experience is the best way to know what to be ready for and improve upon for the next cluster **** you find yourself in.

And I'm gonna tell you now, the first time you have to work on a severely injured child you will either expel your lunch or be mentally screwed for the following couple of weeks, or both. I've never forgotten the first little girl with a severe concussion and head bleed I worked on, I'm just happy that was the worst child case I've had, but still prepare myself for what might be a whole lot worse down the road.

My heart goes out to the heroic souls that worked on those children in Boston today, and more so to those who tried to save that 8yo little boy.

Sorry if I rambled on, but there are some things you just can't forget in this field.


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## Lake Windsong (Nov 27, 2009)

Dakine, I'd like to post this observation in this thread rather than the other one, as I feel it is related to patient care on some levels.

One thing reported this afternoon is that while in shock from the blasts, many people just dropped what they were carrying in their attempts to leave the area. Backbacks, bags, etc. Not only did that create the side issue for police of suspicious bags strewn about, if any of those evacuating had subsequently been injured, many would have possibly discarded their personal information, wallet, etc. in their haste. Having medical information and ICE contact information on your person makes it a bit easier for first responders to expedite your care.


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## Dakine (Sep 4, 2012)

Lake Windsong said:


> Dakine, I'd like to post this observation in this thread rather than the other one, as I feel it is related to patient care on some levels.
> 
> One thing reported this afternoon is that while in shock from the blasts, many people just dropped what they were carrying in their attempts to leave the area. Backbacks, bags, etc. Not only did that create the side issue for police of suspicious bags strewn about, if any of those evacuating had subsequently been injured, many would have possibly discarded their personal information, wallet, etc. in their haste. Having medical information and ICE contact information on your person makes it a bit easier for first responders to expedite your care.


That's a really good point.

For those who dont know, ICE is "In Case of Emergency" and it's stored in your contacts on your phone. This is good and bad... it's good because it lets people reach out to your family, but if you're in my situation, 10 wrong password attempts wipes the device... oops!

That reminds me yet again of the next thing.. I need to give my ex the pw to my phone.


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## Lake Windsong (Nov 27, 2009)

I carry clear waterproof wallet neck lanyards for each of us inside my toddler's diaper bag, since that is my EDC bag. Inside each is a contact/medical information and consent form, photocopies of ID, an insurance card, small amount of cash, and photos of each member of the family in case we are separated. The pic of the person whose medical info is enclosed is easily viewed through the clear material for quick distribution or identification. I have duplicates of these in our BOBs.


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## ras1219como (Jan 15, 2013)

Lake Windsong said:


> I carry clear waterproof wallet neck lanyards for each of us inside my toddler's diaper bag, since that is my EDC bag. Inside each is a contact/medical information and consent form, photocopies of ID, an insurance card, small amount of cash, and photos of each member of the family in case we are separated. The pic of the person whose medical info is enclosed is easily viewed through the clear material for quick distribution or identification. I have duplicates of these in our BOBs.


This is an excellent idea...I need to put something like this together.


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## NaeKid (Oct 17, 2008)

Something that you may also wish to consider is MedicAlert tags or something similar in a military DogTag that would be worn all the time might also be a good ticket item


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## Hooch (Jul 22, 2011)

dakine... congrats on finishing emt school 

I have to agree experience is the best teacher. Volunteering with a fire dept, ambulance crew to keep up skills or a local search n rescue team are all great ways to build confidence in new skills as well as learning real time emergency management. Even if that management is learning to manage your own a$$ in a stressful emergency without tripping over yourself. 

As high stress as situations became sometimes in my own expeirences during my time as a firefighter and on SAR teams...expeirence gains confidence, managing the excitement n adreline rush n still get it done right when it counts is golden. Being realistic with what is best suited for your comfort level n skill is valuable to all and only you really can assess what that will be as you venture out into the various fields. If it's safe, dont pass up a opportunity to try something that wigs you out alittle...You might be surprised at what you thought your not real good at or dont enjoy. I remember I was not real good at first with the first aid part of the firefighting job...I ended up really diggin it n took emt course. I still dont like rope systems all that much but put me in the woods to find someone or something n its a good adventure always..

best of luck!


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## Jim1590 (Jul 11, 2012)

Congrats on the EMT. I spent 17 years doing EMS work, 9 as a paramedic. I was trained in PreHospital Trauma Life Support as well as potential terror weapons so I can speak some to what you mentioned.

As hard as it is to realize, part of the scene safety is making sure the scene is actually safe. A major concern about terror plots or bombings in general are that there are secondary devices that will go off a short time later to kill the responders. Not much you can do about this unless you wait for PD to clear it. Myself, I would rush in as safely as possible even knowing this. BSI is another matter. You want to protect yourself, but don't forget that you want to minimize cross contaimination of body fluids from one patient to another.

You as a new EMT is the one that I would want to be one of the first there if I was incident command. (and yes I have been a incident commander in drills and real calls for MCIs such as accidents as well as a chief medical officer for several large NASCAR races. Nothing like 100,000 drunks at the same time...) As a lower trained (no offense) person, you are more likely to follow the instructions given. Lets say that I ordered you to be a triage officer. Lower levels are more ideal for this than higher. You would start with the first person and assign them a triage level. Different areas have different protocols, but lets look at a simple one. There are 5 catagories. Green would be a walking wounded that is not likely to die if they wander away. Yellow needs to be seen at a hospital at some point soon. Red A needs to be seen at a hospital NOW while Red B can wait for Red A to go first. Black is dead or going to die really really soon. To determine which catagory someone falls into you look at mental status, presence and rate of pulse, visible injuries. You make your determination with 15 seconds. Which is way too long for your job.

You would have helpers if staffing permitted and you would direct them to bring greens over there yellows there and reds that way. Blacks get left where they are. The trick is in keeping greens where they are directed. Each section would have a treatment officer that would re-evaluate. A transport officer and head treatment officer would then decide who is transported by whom and to where. Usually in this type of situation, ambulances are filled to max with very little treatment expected because there is no room to work. Yes this is real life, been there done that. It stinks having to get a set of vitals on 4 people in the couple minute transport while having to balance precariously with no place to sit.

The reason I would not want a medic to do triage is because they know to damn much. Huh, you ain't breathing? Well lets try this, hmm nope, ok intubate, crap no pulse. Shockable? nope, ok "hey need an EMT for compressions!" So they just wasted a few minutes on one person and there are several dozen more they never see. I have seen this happen as well. Not pretty.

Patient care pre-hospital is kinda iffy. Yeah the serious ones will get transported right away and get care enroute but a good transport officer may throw a couple green tags in there to take up seats. Ambulances are not bottomless in supply. Once you are assigned to your patient by the person in charge, you listen to them. Do not deviate, do not wander around, everything needs to work as told so don't screw it up or you have a very irate IC looking for you (yup I have had to lay down the law, I once almost had my shift supervisors med control yanked cause he did what he wanted. The joys of being a Paramedic Field Instructor and he was being stupid ). Idealy the ambulance staging area is out of site so they don't just wander in and grab.

CISD is a good theory but I for one do not subscribe to it. I had my own people to gripe to who understood and I got on with the job. Yes dead kids are a heartache, and I still see their faces whenever I think back on it. OK after just taking a break to stare at a wall for a few... each department has its own form of CISD to roll into place once something happens. With luck whichever department you are dealing with has already thought tthis part out.

I think what you can learn is to watch the people who know what they are doing because they have done it. Ask them what you can do to help them. Take some ConEd classes. Find a PHTLS course and take it. See if you can find out what classes the FD is running and maybe you can proctor some. Avoid the ones that are talking the loudest without anyone seeming to ask them something. They usually do not know what they are doing. The quiet one in the back that does not usually talk about the calls? Watch what they do with a patient. Those are usually the ones to watch.


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