You are sitting watching re-runs of ‘Jeopardy’ and having a beer when breaking news shows a building collapse that has occurred several blocks from your home. Though you think you know the answer to the puzzle, you are torn between solving it before the contestant does and rushing to the scene. What should you do?

  • Solve the puzzle–for one thing, unless you know yourself to be the only provider with the skill set necessary you should not respond to ANY incident after having any alcohol–even if everything goes well, questions will still be asked.
  • Hospital personnel in the field seldom is a good situation–unless you are used to working in that environment you don’t have the protective equipment and scene awareness that you need, and you are not able to medically do what you usually would do so you’re ‘off your game’ and likely to make mistakes–unfamiliar resources, limited capabilities. In Singapore, the airport disaster plan called for ED personnel to be transported to the scene to assist–which was done when a plane crashed on take-off during a typhoon. The ED providers arrived after most of the casualties were already gone, got soaked in their scrubs, many developed hypothermia, and basically contributed negatively to the response as a further drain on organizational resources. An ER nurse who rushed to the Oklahoma City bombing scene to assist was killed by falling debris. And the list goes on. It’s also very difficult to integrate into the response effectively unless you are well known to the EMS providers. So basically, unless you have a response role at the scene, don’t bother going to the site.

After going to the grocery store for more Ho-Ho’s and frozen pizza, you are driving home and witness a building collapse. What should you do?

  • If you happen to be ON the scene of a mass casualty event right after it happens, you can be of significant help in the early minutes to responding EMS personnel IF you can keep yourself safe.
  • Scene safety is critical–park somewhere safe and out of the way of responding public safety. Look all around you BEFORE you commit to helping–including above you… watch out for sharp debris, live power sources, leaking natural gas, further structural collapse potential, hazardous materials (if there’s any natural gas odor or other hazmat risk–chlorine leak or whatever just GET OUT and take as many ambulatory patients as you can with you to a location at least a few blocks away (and upwind, for leaking chemicals).
  • Your primary goal is to start triaging–direct ambulatory patients to a single spot that is safe and recognizable ‘go to the parking lot over there’ and identify the non-ambulatory. Determine which have altered mental status, difficulty breathing, or signs of severe hemorrhage or shock (all ‘red’ criteria)–there’s not a lot of treatment you can do (unless your vehicle is equipped with a spare stab room), but you can be a huge help sorting patients for transport prior to and even after EMS arrival and helping with basic treatments as supplies become available (controlling bleeding, basic splinting, etc.)
  • Be very careful of trying to help ‘rescue’ anybody–unless you are VERY comfortable that there’s no structural issues or electrical lines and no falling debris this can be inherently dangerous–if you have to do something because of an immediate safety threat to the patient don’t worry about spinal precautions, just get the patient away from danger generally by dragging them under the shoulders while supporting the head to maintain what neutral alignment of the c-spine that you can
  • As soon as EMS arrives, hook up with the initial crew and/or a supervisor and identify yourself and your skills – do what they ask you to. If you’re in a different area (not your local EMS system), identify yourself to an EMS provider and ask who the EMS supervisor / EMS command is, then hook up with them and see if you can assist. If you are an MD it’s particularly helpful in our area to let the EMS supervisor know you have a radio number (if you do)–that establishes a lot more credibility and that you may be somewhat useful, as well as can provide orders directly if required
  • Once EMS resources are adequate, if a disaster alert is declared at your hospital consider reporting there. Usually by this time though, unless the incident is truly massive we already have more help than we need at the hospital.