Triage Practice Session
for Southwest Portland NET's
with Lt. Kevin Shanders
Portland Fire Bureau
|Eleven NET team members showed up from 6 different NET teams.||Wear your NET gear, but we will not be using up our personal or team medical supplies.|
|.||On arrival at the Hillsdale NET team's staging area (X), we discovered that a localized tornado had just struck Dewitt Park while a class of children were visiting the park. We left a NET note on a car at the staging area and went on foot north through devastation that got worse as we approached the park -- which is next to Fire Station 5. All the personnel at the station were out on emergency calls. Everything was locked, including the shed in back which has our emergency supplies in it. Between 30 and 40 young children, some very seriously injured, were scattered about the park.||
How would you determine which children needed what kind of attention?
How would you be pretty sure you had located all who needed attention?
How would you get needed shelter for the injured?
How would you get to your emergency supplies?
What would you do about the parents who began to show up?
|On Sunday, October
19th, The Hillsdale NET hosted a triage drill for nearby teams. Lt
Kevin Shanders from the Hillsdale Fire Station facilitated the exercise
at Dewitt Park.
In our scenario,
a tornado had ripped through the southwestern section of the city.
The EMS system was overwhelmed by demands at nursing homes, schools, daycares
and homes. An unconfirmed report indicated that there might be some
grade-schoolers who were visiting a local city park when the tornado hit.
Our team was sent to investigate.
The drill began at the Hillsdale NET’s meeting site behind the bleachers at Wilson High School. After identifying a team leader, safety person and scribe, we proceeded to the park. Once there, team members found 37 “victims” represented by traffic cones. Symptoms were identified on sheets of paper listing general descriptions, respiratory rates, capillary refill times and mental status.
The team agreed on a search pattern. The plan was to separate into two groups who would walk the perimeter in different directions. They would meet at the far side of the scene and return through the center of the park to their starting point.
Overall, the drill was a huge success. In under forty minutes, all victims were found, triaged, tagged, prioritized transported to the appropriate treatment area and treated. Some lessons learned are listed below:
The team leader needs to focus on the “big picture.” It is easy to become overwhelmed. There is a huge temptation to get personally involved in the treatment of individual victims, especially when the team members keep asking for advice. As Keturah became more comfortable in this role, she got better at delegating the small stuff.
The team leader needs to get used to giving orders. Our team leader got better at this as the drill continued. It is important to give team members specific assignments and make sure they follow through. This became an issue while transporting patients to the treatment areas. Teams of four needed to be dispatched to move specific patients. Occasionally, the rescuers would try to “free-lance” and leave a transporting party short-staffed.
Stick to the plan. Team members agreed on a search pattern, but some rescuers began treating patients in any direction instead of circling the perimeter. Subsequently, one patient was not found. (Behind a bush). Other team members kept multiple tallies total patients numbers, but overlapped those counts with those who had actually tagged them. This caused confusion when reporting to the team leader.
Have a plan to direct late-comers. As participants trickled in, we needed a way to direct rescuers to our location after we left the staging area. We left a sign on a conspicuously parked car. The sign told late arrivals how to find the rest of the team.
Access to the NET equipment. The Hillsdale team stores gear in a shed at Station 5. If the firefighters are gone, they don’t have access to the shed. Team members discussed options for breaking into the shed or station if need be.
In the search phase of our exercise, we split into two sets of two search groups two going to the left and two to the right. I believe that for the particular situation we were facing we would have better formed a line across the bottom of the hill (at the street) and worked our way up the hill tagging the victims as we went while keeping notes to give to the team leader after we finished, especially noting the "Immediates.". (This would have required those on the ends to fan out at the beginning and the end.) I believe we would have finished the search within five minutes rather than the about thirty it actually took us to finish. The way we did it, we had far too much duplication of effort. The biggest problem I saw was that of the two groups on each side, the second group couldn't be sure of what the first group had done. Also, in our situation, highly visible flags (strips of cloth, perhaps) that identified the Immediates would have helped get them to the care area faster.
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