Administration and Leadership, Airway & Respiratory, Mass Casualty Incidents, News

Agencies Come Together to Face MCIs

Issue 10 and Volume 37.

Have you noticed how well personnel from different agencies—and those wearing different uniforms and shoulder patches—get along and work together during a cardiac arrest or mass casualty incident?

Know why that is? It’s because they’re all focused on a common goal: the mitigation of a complex incident or resuscitation of a person whose life will slip away if they don’t focus on the most appropriate care, set aside personal biases about who’s in charge and follow the command system regardless of who’s “in charge.”

I’ve found this to be the case during most “big” calls. But when you get public, private, third service and hospital-based EMS system administrators together for a planning meeting or at a city council hearing on the best way to offer EMS in a region, their protective attitudes, operational and staffing biases, and agency loyalties, will often surface like the teeth on a shark that smells blood in the water.

It shouldn’t be that way. We should check our egos and biases at the door whenever we leave home to head to work. We should simply focus on the patient and delivering optimal service to the community.

Wars have taught us invaluable lessons about strategy development, command and control, and the use of innovative tactics. They have also taught us many hidden lessons about group interaction, the use of limited resources and, most importantly, “blind” faith and cooperation between forces from different service branches without bias or prejudice—particularly when it comes to combat casualty care.

The importance of this unbiased attitude and approach to patient care was never more evident to me than in the sad, but powerful, story of the life and tragic death of Sgt. Eric E. Williams, an Army flight medic from Southern California who was killed on July 23 in Afghanistan.

At Williams’ funeral, Army Staff Sgt. Michael Constantine told of being on the receiving end of Williams’ care in 2008, and vividly recalled the battle that almost took his life. A bullet tore through Constantine’s ribs and collapsed his lung during a fierce battle in Afghanistan.

Sgt. Williams was the flight medic who rapidly arrived on an Army helicopter to attend to him as he gasped for breath, watch his vision begin to fade and “tunnel,” and had a significant amount of blood filling his airway.

Constantine says, “I had started to give up and let the inevitable rush over me until, in a calm voice, I heard Williams’ voice say ‘Just breathe out.’ So I did.”(1) He then felt Williams’ hands repairing his massive, open wound.

Constantine says he looked up and searched the medic’s face for some indication of how bad the wound was. He told those in attendance at his funeral that he was met with a reassuring smile and words of promise from Williams, who told him he would do all that he could to save him.
Williams and his flight crew members did, in fact, save Constantine, and he never saw Williams again.

In July, four years after Williams saved Constantine’s life, he learned that Williams was killed as his second deployment ended. Williams was in transit from his duty station in Ghazni Province, Afghanistan back to the U.S., and his forward operating base came under enemy fire.
He never made it home, but the stories of his heroic acts did.

The most important part of this story is that Williams grew up in civilian life serving with public and private emergency response agencies. He had served as president of the fire explorers while at Murrieta (Calif.) Valley High School and later became an EMT for American Medical Response.

He did his job then based on what was in the best interest of his community and his patients. Later, while serving as a medic in the Army, he provided care indiscriminately to those in need whether they wore a patch from the Army, Marines, Air Force, Navy or Afghanistan military—or no patch at all.

During his memorial service, the last entry in Williams’ Internet blog entry titled “Coming Home” was read. In his short blog message, the dedicated, humble Army medic noted having witnessed “the atrocities of war” and wrote words that sum up why we all work in the field of EMS:

“We have thrust ourselves into the midst of chaos in order to do something so important, so visceral, that few will ever understand what it means. We collectively have risked it all and put everything on the line to save our fellow man, regardless of nationality, race, religion or sex.”

Remember Sgt. Eric Williams’ ultimate sacrifice and never let personal bias or your agency affiliation stand in the way of patient care or decisions that are the best interest of your patient or the community you serve.

We all have to accept and embrace the fact that we will always wear different shoulder patches and have different employer-driven philosophies and service objectives. But we must work cooperatively together, particularly in the years ahead as new approaches to healthcare delivery require a more comprehensive, integrated EMS delivery model.

1. Kabbany J. (Aug. 4, 2012). WILDOMAR: Region remembers slain Murrieta soldier. In North County Times. Retrieved Aug. 4, 2012, from