The first thing we teach new EMT students -- and for that matter drill into them for the remainder of the class -- is scene safety. A large part of this involves the proper selection of personal protective equipment (PPE) for the job. When you think of a mass casualty incident (MCI), the first thing that comes to mind may be the need for bloodborne pathogen protection. Instead, let's look at how our everyday "work clothes" may protect or harm us when it comes to MCI operations.
A number of recent winter MCIs demonstrate that these incidents can and do occur in inclement weather. When it comes to cold-weather operations, certainly our colleagues up North seem to be more prepared than those of us in more temperate zones. But, even in my home state Ohio, where we have 90-degree summers, the winter bite on a 12-degree night can be very unpleasant, even at a "simple" motor vehicle crash scene.
With most calls, we can limit our exposure to the cold by quickly packaging the patients and moving them to the ambulance. But at an MCI, providers may have to work in the cold for extended periods of time. Because providers may be our scarcest resource at an MCI, we need to look at ways to get the most operational time out of each one. At the same time, we don't want to put them at risk of becoming patients themselves.
We can do a few things to maximize work time in cold weather. Each of us should consider carrying a jump kit with additional clothing (e.g., socks, gloves, sweaters) that we can access if working a cold scene for an extended period of time.
For volunteers or off-duty personnel responding from home, if you know in advance that you're responding to an MCI, take a few extra minutes to put on long underwear, add layers of clothing and grab some extra clothes (if your jump kit isn't accessible). It's well worth it. Delaying your response a few minutes to take these simple steps could extend the amount of time you can work at the scene considerably.
At the department level, consider keeping extra warm clothes in a gear bag or container on one of the response vehicles, so supervisors can hand it out on the scene. Also, command personnel should plan ahead and request such resources as rehab units or buses that can be used as warming stations for response providers. Your MCI plans probably already address where you can obtain buses to use for transporting the "green" patients, so why not request one or two more that could potentially save your own?
At the other end of the spectrum, let s consider whether it s necessary to wear turnout gear during warmer months. Yes, it protects you from heat during a fire, but it also puts you at risk from heat stress when operating at non-fire incidents, where that level of protection isn't warranted.
For example, I recall a summertime drill at a major Midwest amusement park. The scenario was multiple tornado touchdowns in the park. I was serving as an evaluator in one area, and a number of the providers were assigned to move patients on backboards from the "treatment area" to the "loading zone" a short distance away. They were all wearing turnout gear. The sun was shining brightly, and it was obvious that the firefighters carrying the backboards were feeling the heat.
As evaluators, we weren't supposed to get involved in operations, but I tactfully suggested to a number of firefighters that they at least lose their turnout coats. To my surprise, many of them, who were panting and sweating, said, "no," and that they were fine. I mentioned that I didn't think any of their patients were going to spontaneously combust on the way to the ambulances. After consulting with drill directors, we ordered providers to remove their hot coats for their own good and the safety of the drill's volunteer patients that the firefighters were carrying. The last thing we wanted was to have a simulated patient become a real patient after being dropped by a fatigued firefighter.
I'm not trying to dictate policy here, but think about it. Firefighters dropping from heat stress at the scene of an MCI only add to the patient load and impact the availability of a scarce resource -- namely, providers. Command personnel should make this clear: Although the emergency responder came in on a fire truck, depending on their assignment, they may be operating in a medical role, not a fire-rescue role. Place turnout coats and helmets (and possibly even bunker pants, depending on the type of footwear worn) where they can be retrieved quickly should firefighters be reassigned to work in a more hazardous environment where such clothing is appropriate.
The bottom line is: Use good judgment, and be reasonable. Solve the problem by wearing clothing that provides the appropriate level of protection and will support the mission and your ability to operate for an extended period. Don't add to the problem by becoming a victim of the cold or the heat.
To read more about the Flight 1404 MCI shown above,click here.