0400 Wednesday night shift
You sip your
coffee international roast beveragefatigue management supplement and the phone rings…..
“Hey, it’s Rob, an IC paramedic from QAS. There’s been an explosion in the valley!! It looks like we have a large number of critically injured young people outside a club on Wickham street – its looks like a mixture of blast trauma and burns at this stage. Can you send a team to the scene?!!!”
You call your consultant who advised you go straight to scene and she will meet you there………….
Who coordinates our emergency medical systems and medical response in incidents and disasters?
QEMS is the Qld Emergency Medical System.
The QEMS Coordination Centre (QCC) functions from a joint facility in Spring Hill between QAS and Qld Health’s Retrieval Services Queensland (RSQ) division.
QCC operates 24hrs a day
- Coordination, clinical governance, credentialing, oversight, quality control
- Nursing Coordinators
- Medical Coordinators (RSQ staff or CMS contracted)
- >20,000 Retrievals/Transfers per year (25% Paeds/Neonate or high risk obstetric)
You arrive on scene and are fronted with multiple burnt, screaming patient. Some mobilizing. Some not moving. A well meaning but not immediately useful crowd is in attendance.
OK, you are now – hopefully briefly – the only doctor on site at a disaster. What do you do now???
Sieve and Sort
The basic concept is to (capital T) Triage to “do the most for the most”. Deal with life threats to enable rapid Triage/Treatment/Transport.
When there are multiple casualties initial assessment can take place with the Adult Triage Sieve.
The sieve can be applied by an experienced paramedic or doctor on scene, and is designed to RAPIDLY triage to 4 groups ((1) Immediate, (2) Urgent, (3) Delayed and Dead).
After using the sieve to triage and moving disaster patients to a casualty clearing station, the Revised Trauma Score can be used to sort.
By using GCS, respiratory rate and systolic BP a score is calculated, priority can be assigned and casualties can be distributed to appropriate receiving hospitals in an appropriate distribution.
You conclude you have 12 reds and yellows with up to 15 greens and start to think about the best way to move people to definitive care….
Well, this is pretty easy when the site of the incident is close to the hospitals that can provide definitive care. It is possible to summarise the attributes of road, fixed and rotary wing transportation as below:
|ROAD||ROTARY WING||FIXED WING|
|COST||Cheap||4 X FW||Expensive|
|Secondary T/F needed||No||No||Yes|
|Procedural space||Limited||Extremely Limited||Limited|
|Flexible landing sites||Yes||Yes||No|
|Response times||Instant||Fast (2-10min)||Slow (15-30min)|
Your boss arrives to take over the scene and sends you back to prepare ‘the hospital’!!!
Major Incident Medical Management and Support Approach (MIMMS)
C – Command and Control
- Emergency operations room
- Delegation and Roles
S – Safety
C – Communications
- Vertical vs Horizontal
- Devices – radio, phone, PA (probably on bypass)
A – Assessment
T – Triage
- Red, Yellow, Green vs ATS
T – Treatment
- Teams to be consultant lead by specialty
T – Transport
- T/F of critically Ill vs Transport of walking well