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 unfold.
The training, however, was very real as emergency medical service providers, firefighters and rescue workers at the Las Vegas Convention Center parking lot took place in a staged mass casualty incident as part of EMS World Expo on Wednesday evening.
In all, 35 patients, about 100 first responders and a parade of apparatus and ambulances converged on the scene of the drill which was hosted by the Clark County Fire Department. The event was organized and sponsored in large part by EMS World and its parent company Cygnus Business Media.
"It was the first time we've ever done this and I think we'll do it again," said event organizer Mary Flynn, EMS World show manager. "...We got a proposal to do a mass casualty incident in the parking lot and we decided to go for it."
Flynn said North Las Vegas Fire Department Capt. Travis Anderson was hugely instrumental in organizing and scripting the actual scenario, and making sure all the details were handled from the donated bus and the towing company that helped stage the event.
Other corporate partners, including Simulaids, Cypress Creek EMS, iSys Global, StatBand and TEEX helped sponsor the event.
With temperatures over 100 degrees, more than two dozen EMT students, all in their first week of classes, climbed inside the bus or in one of the cars, some covered with moulaged injuries.
With the stage set and cameras in place from numerous area news agencies, an alarm was sounded for a school bus accident in front of the convention center with possible injuries and entrapment. Using a North Las Vegas Police Department incident command vehicle, radio transmissions from the whole scenario were broadcast over a public address system so spectators could listen.
Narrating the event was Bruce Evans, Chief of the North Las Vegas Fire Department EMS Division.
"Whenever we have a situation like this, we usually strike a first alarm response," Evans said, noting that when units arrive on the scene, additional resources could be summoned.
And, sure enough, the first arriving units, quickly assessed the scene and determined there were more than a couple of dozen victims, some critically hurt and many of them entrapped.
"When you have a mass casualty incident, it's always best to send resources for at least five victims," Evans said.
And did they ever have more than five. When the final count was taken, there were 35 victims ranging from walking wounded to four dead at the scene.
As the severity of the incident became apparent, units from Clark County Fire Department, Henderson Fire Department, Las Vegas Department, North Las Vegas Fire Department, Henderson Fire Department, and police agencies from Las Vegas Metropolitan Police Department, North Las Vegas Police Department and three private ambulance companies were summoned. Even a crew and heavy rescue from nearby Nellis Air Force Base participated in the drill.
Treating it like a real scene, fire units came in and took positions according to command's assignment and began going to work.
Triage was practiced immediately and those who could walk were asked to follow a firefighter out of the "hot zone" to await treatment and transport if necessary.
Other crews climbed inside the bus through three different points of entry: one roof escape hatch that was cut to be much wider for extrication and access; through the back emergency door; and through the front windshield after it was removed from the front of the bus.
Another team used hydraulic rescue tools to remove patients from a two-door sedan that remained on its wheels after it crashed into the rear of the bus. Still another team focused on the four-door sedan on its roof with one patient partially ejected and likely dead from the impact.
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.
In a debriefing after the event, Jenkins said he was pleased with the performance of all those involved and said it shows that the agencies in the greater Las Vegas area can, and do, work well together.
In an interview with EMS World Expo staff, Jenkins said pulling the MCI together was a lot of work, but it was worth it.
He said he was also pleased to be able to showcase the talents of those in the area.
"We had people, our peers really, from all over the world in the audience, looking and listening," Jenkins said. "And that was pretty cool."