MCI Drill Showcases Vegas-Area Teamwork

LAS VEGAS -- The scene was surreal: a bus on its side with two heavily damaged vehicles smashed against it, one on its roof against a backdrop of the glitzy Las Vegas skyline, with several hundred spectators seated on bleachers watching the rescue...

Working progressively and safely, responders got the last person out of the vehicles after about an hour on the scene.

EMS personnel provided advanced life support to trapped victims, including intubation. Not all the victims were live. Many were EMS manikins, including the one that was partially ejected out of the overturned car.

As patients were extricated and given rudimentary care, including neck collars and back boarding, they were moved by personnel in bunker gear to a medical staging area for additional treatment and transport as necessary. A cache of ambulances, both public and private transported patients from the scene. In this case, that meant a trip around to the back of the convention center where they simulated a trip to the hospital for definitive care.

Evans told the audience that as soon as an MCI is confirmed, dispatch automatically starts calling the area hospitals to let them know what they have so the hospitals can begin to prepare and start calling in staff and specialists as needed.

A metro transit bus was also summoned to the scene to transport the walking wounded and people with minor injuries.

"Think about being out on the road someplace and the temperature is 110 degrees, Evans said.”You are going to want to have some place to keep those patients cool while providers and commanders figure out where they should go and how they could get there. Using a bus for minor injuries was a good take home tip, Evans said.

Keeping control of patients is important as well, Evans said, acknowledging that accident scenes are often chaotic - even when planned in advance like the drill.

Patients who stray away from the designated areas can often skirt incident management and get transported to the hospital without any, or sufficient on-scene treatment.

"We don't want the disaster moving from the scene to the hospital," Evans said.

One way to do that is to create an hour-glass scene where there are wide spots on either side for operations and transport and then an intentional funnel between the two to make sure the right patient is headed to the right spot for care.

It is also important to take care of the deceased victims as well to preserve their dignity for their families, Evans said. In a real MCI with fatalities, the Las Vegas coroner's office would have been summoned immediately.

It's interesting to note that fire departments in the region have been asked not to put blankets on the deceased for fear of contaminating evidence, Evan said. Blankets even washed and clean, could potentially transfer hair follicles or minute pieces of skin and other material to the corpse.

"We don't cover victims any longer, unless they are in plain view of the public.”

On that note, Evans said that if there are many fatalities in an MCI, it's important to figure out where the deceased will be taken and stored. One suggestion is meat packing companies with refrigerator trucks; another would be an ice skating rink where the bodies could be placed on the ice for preservation.

"You can imagine what would happen if they were left out here in this heat for too long," said Incident Commander Trent Jenkins, a battalion chief with the Clark County Fire Department.

The heat also took its toll on the firefighters, rescuers and EMS providers. As soon as the incident was done and the last victim extricated and transported, Jenkins ordered the crews to rehab.

For big incidents like a bus crash, a special rehab unit is dispatched and sent with one firefighter paid at overtime rates.

"It's basically an oversized refreshment center filled with water and Gatorade and Power Bars," Evans said.

The incident even had a designated Public Information Officer who did both on-camera and print press conferences.

Deputy Fire Chief Kevin Brame, of the North Las Vegas Fire Department served in that position.

He said in an interview that the event went well, and other chief officers on the scene were pleased at how smoothly everything worked.

"Like everything else, we know we can make some improvements," Brame said.