By Jo Carrerow
The Appeal-Democrat
YUBA CITY, Calif. — At Bi-County Ambulance’s Mass Casualty Incident training Wednesday, there was a sense of immediacy, although the planned enactment was to prepare first responders for potential emergencies in the upcoming Sikh Parade.
Dara Dunn, an emergency medical technician and education and training specialist for the ambulance company, led a group of about 15 regional firefighters, ambulance employees and EMTs through steps they would take if a crowd of people was injured in an accident. She has been organizing the training for 20-plus years and made sure it went as close to a real disaster event as possible.
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“We do a big push every year in October in preparation for the Sikh Parade because it has a potential for an MCI event,” Dunn noted.
The challenge is the Sikh Parade, held this year on Nov. 1, attracts about 150,000 attendees from around the world to Yuba City, which has a total population of 70,000.
Conducted outside the Bi-County Ambulance building on Poole Street in Yuba City, members of Meridian, Linda, Yuba City and Sutter fire departments assumed their roles and asked Dunn questions before searching for the patients.
“I’ve got to ask, is this a trampling incident, or a drug incident?” Yuba City Fire Department Captain Justin Johnson inquired.
Dunn answered, “It could be both,” before clarifying, “it could be trauma and drugs.”
One thing that was apparent to this reporter is that handling an emergency of this magnitude is a lot more difficult than people realize. Prior to moving outside, the trainees met inside to discuss the procedures of locating victims, triaging them, choosing which color-coded tag best describes their conditions, then putting a tag around the patient’s neck and the matching one in their pocket to give to the medical comms (communication) coordinator, who for this group was Bi-County paramedic, Jerry Hofmann.
Participants started their training by watching a film created in Ventura County that depicted a mass casualty event in what one dispatcher called a “bloody incident.” The players performed their duties and sent the patients off to their appropriate destinations in perfect orchestration, according to Dunn.
“That’s our ultimate goal at MCI, to try to get the victims off the scene,” she noted.
Dunn explained that in an MCI event, an alert is sent to each of the area hospitals — called control facilities. About five to 10 minutes later, emergency personnel usually know how many beds are available.
“A surge alert is set up for an event where you have three or more units, whether it be ground or air,” Dunn said, adding that our area is unique in that there are no other hospitals within 45 miles that have the capabilities that Adventist Health & Rideout has.
The alert is utilized even in cases like a four-car collision where nobody is hurt, “but patients may or may not be going to the hospital,” Dunn advised. Alerts also go out if there are three or more patients involved.
Incidents are rated by level, with level one consisting of up to 14 patients, level two from 15 to 49 patients, and level three with 50-plus patients.
“To get 50-plus patients triaged, sorted and transported, it’s going to be a lot of work,” Dunn observed.
A participant suggested they could bring in buses for transporting large groups of patients.
“You’re probably not going to find a hospital that’s going to accept that amount of people,” Dunn pointed out.
She asked if they had thought about where an air ambulance could land during the Sikh Parade.
“It’s not going to happen,” said Yuba City Fire Battalion Chief Eric Hankin , later adding that they would have to be careful not to land in the “travel route.”
They ultimately decided an ambulance would have to transport the patient to the aircraft.
Dunn went over different scenarios, describing patients in varying levels of injury — those who are bleeding, or incoherent, or not breathing. Also, babies, or children, or pregnant women.
“The problem is, we need to know which patient has the worst injury,” she instructed.
Each of the 16 cardboard “patients” was labeled with what their vitals were during their first and second triage. They were hidden all over outside and inside a warehouse where strobe lights and loud music were set up to simulate the chaos during an MCI event. After locating them, they were marked with color-coded tags — green for minor, red for immediate, black for deceased, and yellow for delayed — and placed on colored tarps that matched the tags.
Dunn noted that one of the patient’s conditions went from delayed, where he was conscious and could walk, to going to the morgue.
“It’s a sad sort of reality that happens in large incidents,” she reflected.
During the exercise, a couple of tags were missing and those patients needed to be re-triaged. They worked together and eventually all the tags were matched.
Dunn indicated their training exercise ended quicker than it would at an actual catastrophe.
“In a real event, these guys may not be able to talk to each other,” Dunn said, explaining that a runner would be going back and forth to relay information.
The MCI training is important for all first responders, but especially crucial for those new to the field, according to Meridian Fire Chief Robert Stoddard, who also is a Fire Technology coordinator at Yuba College.
“Most everything we do, you have to review it,” Stoddard said, citing that it becomes “muscle memory.”
He also stressed the importance of working with other agencies.
“Joint training like this is critical,” the veteran fire chief reflected.
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