Mass Casualty Training in Washington Prepares People for Disaster
April 05—There's never been a catastrophic bus crash in Yakima, but if there were, local medical students would be ready.
On Saturday, students from Pacific Northwest University of Health Sciences and from Heritage University's physician assistant program participated in a mass casualty drill, organized by PNWU students and assisted by area fire departments and EMS teams.
This is the at least the third time students have put on the drill. Last year, they simulated a multiple-vehicle car crash, said student organizer Eugene Bistrika, a second-year student at PNWU and president of the school's emergency medicine club.
The exercise was open to all students in return for $5 fee to cover costs. The fee was waived for emergency medicine club members.
But Bistrika said the fee was minimal compared to the experience they gained. "The type of training here people pay hundreds of dollars for."
Saturday's crash was staged with a loaner bus from East Valley School District and used Boy Scouts and students' family members who plastered themselves with fake wounds and role-played varying degrees of injury.
The students carried out various roles, including triaging patients inside the bus or treating them at different triage areas marked by colored flags on the field behind Butler-Haney Hall. Emergency responders were on hand to provide guidance and help to the students during the drill.
The daylong event began with two hours of training on how to triage patients in a mass casualty incident, led by Jeremy Rodriguez, an instructor with Yakima County Emergency Medical Services and a lieutenant in the Yakima Fire Department.
After that, the students put what they'd just learned into practice, rotating through different positions in the incident command structure and figuring out who in the bus crash could walk, who needed immediate transport, and what kind of medical treatment was required.
The drill was done several times. After each round, emergency responders would provide feedback that students could apply during the next drill round.
It's the best kind of practice they'll get without actually experiencing a mass casualty, said Bistrika, who worked as a firefighter for several years in Hoquiam and as a medic in Arizona.
"The only thing that can really prepare you for a mass casualty like this is massive amounts of training. That's what any fire department does ... countless hours of training and competitive work to get this as close to right as possible," he said in an interview conducted last week.
"We understand that it's not going to be a perfectly run scene, but it'll give students good exposure of what it's like to manage a catastrophic incident like that."
Learning to triage in the field not only helps prepare medical students for the often-chaotic emergency room, but it also fosters better understanding and communication between the future doctors and emergency responders, such as firefighters, ambulance crews, helicopter medic teams, and even the military.
That's one of the reasons all the agencies Bistrika asked were more than willing to participate, many on their own time. When he approached Northwest MedStar about bringing a helicopter, he said the response was simply, "What time do you need us?"
After the bus crash scene, a Northwest MedStar medic taught a "difficult airway" class for students.
East Valley and Yakima fire departments and Yakima County Search and Rescue also participated, while local doctors Tom Eglin and Bill Hatch helped organize. Bistrika tried to coordinate with the Yakima Training Center to get an Army crew to land a helicopter on campus to demonstrate an emergency hoist, but scheduling didn't work out. Multiple agencies were invited so that if one had to run out on an emergency call, the drill could still continue.
"I think we have an obligation in the emergency services community to try and be as prepared as we can be, and training is a big part of it," Rodriguez said. "So when we get on the scene, and we're all talking the same language ... the pieces of the machine all become interchangeable. That's one of my goals."
He's helped out with every one of PNWU's mass casualty drills, and has provided the instruction for all but the first one.
"I love teaching, especially when I'm teaching new people or inexperienced people, because the opportunity to see them as the light bulb turns on is really rewarding for me," he said. "Most of them are so enthusiastic. They want to learn—that's why they're giving up their Saturday. It makes it a lot of fun."
They teach him, too, he says, each year coming up with new questions or new ideas he hadn't thought of before.
For the 50 students participating, the drill provides a valuable hands-on experience and is a nice shift from hours in the classroom. The exercise was also scheduled after major exams, so more students could participate, Bistrika said.
"It's fast-paced," said Taylor Brown, 23, a first-year PNWU student. "Sounds exciting. (It's) something new."
Grace DeHoff, 26, also first-year student at PNWU, liked the opportunity to be exposed to different roles. She also was pleasantly surprised how much she was able to use her prior experience as an emergency medical technician in the exercise, especially in the triage process.
"It's just a nice reaffirmation of your skills," she said
The triage structure used in an accident scene can provide a model for physicians working in the emergency room, she said. "You're going to have to (have a structure) if you want to treat everyone property."
Since MCIs (mass casualty incidents) are rare, emergency responders know opportunities to train like this are valuable to their work.
"It becomes very easy to become intimidated real quickly, especially for entry-level firefighters. Guys who are low on the seniority totem pole are asking, 'Where do you start?'" Rodriguez said.
Whether it's new firefighters or medical students in a drill, he tells them the same thing: Establish command, and establish a plan.
"You start where you're standing," he said.
