tag:blogger.com,1999:blog-714028479313834812.post2662066993589136610..comments2024-03-28T11:58:42.109-07:00Comments on Raconteur Report: These Are My PeopleAesophttp://www.blogger.com/profile/07834464741531503378noreply@blogger.comBlogger9125tag:blogger.com,1999:blog-714028479313834812.post-11188272888815692712017-11-15T21:35:48.527-08:002017-11-15T21:35:48.527-08:001) If you do NOT know Clarence Moore out of Clevel...1) If you do NOT know Clarence Moore out of Cleveland (OH) EMS you should. He enjoys taking over hospitals, all by his lonesome, and does it fairly regularly.<br /><br />2) Guy name of Dr J. D. Polk maintains that the absolute best Triage System is an EMT fully trained in the START Quick Triage System. If someone has an MD or DO after their name he or she needs to be MILES away from Triage.<br /><br />3) Friend f mine ws the MCI Disaster Team Charge Nurse for UMC that Sunday night. She is JUST getting to being ble to talk about it....STERLING CISM, guys [/SARC--muthafeckers!!!] She is a damn good Nurse and good kid. 'S'only been a muther fuckin MONTH!!!! (Wife has sat on a Regional CISD/CISM board so.....)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-37706419508702875772017-11-15T12:46:13.710-08:002017-11-15T12:46:13.710-08:00Would that you could do that Aesop. If you ever CA...Would that you could do that Aesop. If you ever CAN, I'll break a rule and come back to CA to help in any way I can. <br />BT<br />Gary Griffin<br />I was not referring to "standards of care"; our situation would be getting one of our guys TO someplace with at least a line in. Whether by medevac or bringin him in ourselves we only had what we had and that's one set and a 500ml bag per guy, with maybe a 1000ml bag per in the boat. <br />Boat GuyAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-85253762602421374642017-11-15T08:54:02.495-08:002017-11-15T08:54:02.495-08:001) Boy and girls, just to be clear, three of the E...1) Boy and girls, just to be clear, three of the ER docs in that pic are D.O.s (Doctor of Osteopathy). The "dentists" line was a comment.<br /><br />2)@ froginblender<br />Most ERs everywhere forever run on the ragged edge of disaster every fricking day, 24/7/365. The luxury of playing MCI games is reserved for fire and EMS guys <i>off-duty</i>, and they're mainly dog-and-pony shows to stroke someone's ego, not actual training.<br />If I were emperor, one day a year, rotated so only one facility at a time was closed, I'd throw the Mother Of All Disasters at every ER in the country, I'd pull the power plug out an hour into it, and somewhere during the festivities, there would be combative family members and an active shooter or IED explosion in the triage area. Two hours in, someone would either have Ebola or come in covered in anthrax or Sarin. Three patients of different ages/sexes would have the exact same name, and 20% of them wouldn't speak any English.<br />It would start two hours before shift change, and cross over into night, or vice versa. Ideally, both, in two exercises, run twelve hours apart.<br />I'd have 50+ patients from child to senior citizen-age, 50 hands-off grader/observers, and 50 video cameramen, I'd put GoPro bodycams on all the staff, and the entire thing would get an NTC brigade-level debrief afterwards, and be edited down to one helluva debrief documentary for wide dissemination on DVD and YouTube.<br /><br />No one above the level of charge nurse (no suits, no managers/directors/CEOs) would be allowed within 100 yards of it while it was happening.<br /><br />I'd do one a month just in my county, I'd bring in make-up, prop, and FX artists from Hollywood productions, and they'd be mother-effing EPICs.<br /><br />And everyone there would go home sweaty, and needing a change of underwear, but their damned paper plans would get ass-raped, and they'd learn how to play jazz instead of opera.<br /><br />And the line to play in the next year's exercise, as both participant or test-takers would be around the block.<br /><br />It was how *I* was trained, <i>before</i> nursing school, in a course exponentially more challenging than my degree, and I'm here to tell you it works.Aesophttps://www.blogger.com/profile/07834464741531503378noreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-71467393275110355692017-11-14T21:14:55.013-08:002017-11-14T21:14:55.013-08:00If only the EDs across the country knew about thos...If only the EDs across the country knew about those dentists . . .Deanahttps://www.blogger.com/profile/14447566763139743519noreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-49689497283888132032017-11-14T21:01:30.687-08:002017-11-14T21:01:30.687-08:00"
I would also have thought that at least ev..."<br /><br />I would also have thought that at least every three years, a large-scale exercise"<br /><br />Mnnnn, not as such. Can't just close the ER for the exercise. Can't divert all the staff that are barely getting the normal work done.<br /><br />I did wonder what the official hospital MCI 3 ring binder had in it, and who developed that plan, but then I remembered-- NO ONE really expects the emergency plans to be implemented, so they are rarely practical, and often put off or given only a cursory effort.<br /><br />Finally the MC exercises I've been part of or read the AARs usually set pretty modest goals. The organizers know that their plans won't work (see clauswitz) and they don't want to hammer the participants. You want the participants to learn SOMETHING, not just get frustrated. For example, the exercise never starts with a trainer counting off every third person and telling them to sit down because they didn't make it in to work because the bridge was out. Or telling the first 3 sets of rescuers they've died from chemical exposure and won't be participating further.<br /><br />Read the AARs from Cascadia Rising (which just took place recently.) Read some of the AARs from non-official agencies, like hams or CERT teams. It was a giant cluster grope and people were lucky just to get COMMS working. <br /><br />These guys in Vegas were rock stars. They saved lives, and pulled miracles out of a hat. In the end, it wasn't the plan in the 3 ring binder from the 'table top exercise' three years ago, it was down to the people on the floor making good decisions, recognizing the extraordinary nature of the incident, and responding to what was actually happening.<br /><br /><br />Now, flip the script. Think about what a coordinated series of attacks, or several in the same place in a row, would do to the local response. Think about what would have happened if the attacker(s) just kept shooting. Gut clench? Chest get tight?<br /><br />nickAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-38412424078248644372017-11-14T20:10:42.209-08:002017-11-14T20:10:42.209-08:00A lot of the bottleneck/flow analysis is pretty ol...A lot of the bottleneck/flow analysis is pretty old hat in the Lean/Toyota Production System/Theory of Constraints world. Is that kind of analysis typically done in ERs? I would hope it was being done on a pretty ongoing basis in ERs and not just for mass casualty incidents.John ShootBetterhttp://www.magsquad.comnoreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-43982242342457262452017-11-14T18:49:50.493-08:002017-11-14T18:49:50.493-08:00"For years I had been planning how I would ha..."For years I had been planning how I would handle a MCI, but I rarely shared it because people might think I was crazy."<br /><br />Maybe I'm reading this wrong, but why did he keep the plan to himself? I would have thought that the ER dept in his hospital practice a dry run for a mass casualty incident at least once a year, in which he would have had the opportunity to contribute his plan and have it evaluated.<br /><br />I would also have thought that at least every three years, a large-scale exercise involving several hospitals, ambulance services, cops, fire dept, and whatnot is held to simulate a multi-agency exercise in the metro area, with thorough post-mortems to spot where improvements are needed.froginblenderhttps://www.blogger.com/profile/01534104165268993436noreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-22805328475904297092017-11-14T17:22:41.249-08:002017-11-14T17:22:41.249-08:00Trauma victims get 2 lines (standard of care). Den...Trauma victims get 2 lines (standard of care). Dentists usually make the best triage leads with RN's a close second. Never allow a surgeon anywhere near the triage area. It sounds lime you may have danced to a waltz like this before.Gary Griffinhttps://www.blogger.com/profile/06890235239328637648noreply@blogger.comtag:blogger.com,1999:blog-714028479313834812.post-69968599244636155022017-11-14T15:28:33.088-08:002017-11-14T15:28:33.088-08:00Read this via Peter's site. One of the things ...Read this via Peter's site. One of the things we were taught was to get a line in, even if the bag ( We had half liters on us) went dry, at least there would be a line.<br />Boat GuyAnonymousnoreply@blogger.com