Responding to a mass casualty incident is unimaginable

First responders are trained to respond to emergencies, but many are unprepared for the unbelievable trauma that accompanies a mass casualty incident


“No, you can’t imagine!” he shouted, betraying his claim that he was okay. What started as a friendly conversation had become more serious, as the real reason for the call poured out of him. He had read an article I had written about arming EMTs and paramedics, agreed with my belief that it would do more harm than good, and wanted to let me know.

I probably wasn’t the first to tell him, “I can imagine,” when the topic came up. He was the first paramedic on scene at the 2012 Sandy Hook massacre in Newtown, Conn. He was right; I cannot imagine. I cannot imagine what the first responders and law enforcement personnel have experienced in Orlando, London, Paris, Las Vegas, Parkland, Santa Fe or any place where a group of innocents are murdered. I may have thought that I could, but once I heard the raw emotion in the voice of somebody who does not have to imagine, all pretenses that I somehow understood because I wear the same uniform were gone forever.

I can imagine going to work and dealing with the usual rigmarole, thinking everything is under control, looking forward to the end of the shift, confident that I will go home and everything will be okay. I have seen my share of tragedy – far more than the average person – and live with it. I don’t get overly worked up when somebody tells me they can imagine what it is like to be me, because maybe they can.

The amazing thing is how many people take for granted that people like us will be available, and are surprised when one of us falls. (Courtesy photo)
The amazing thing is how many people take for granted that people like us will be available, and are surprised when one of us falls. (Courtesy photo)

I never gave much thought about what goes on at a mass casualty incident once triage is done, patients are transported and some semblance of order is restored. It didn’t occur to me that somebody had to check the dead for signs of life. Every body must be thoroughly examined, pulses checked, an EKG performed and pupils examined.

I never knew, until Bernie told me. He had to check 27.

Far too many of us have had to do similar, essential things. People have laid dead on a dance floor, a concert hall, an outdoor venue, schools and those no-longer isolated places where violence and mayhem interrupt daily living.  There are people doing a job that nobody can imagine doing, except those who have done it. Cell phones ring from the pockets of the dead, as frantic family members call while holding out hope, each ring tone different, breaking what must be morgue-like silence with the heartbreaking music. And, through the gore, our people do their jobs, and carry on in unimaginable conditions.

How quickly it all ends; people dancing or learning , loving life and each other, expressing themselves in some of the few places where they can be themselves, free from the judgment of family and society, free to just be, free to learn and laugh. Hours later, other people in the same space, responding to what, for many of them, will be the defining moment of their careers. Some will last, some will not. I wouldn’t, that much is certain.

Prepare for the trauma you may encounter in EMS

War and work are two different existences. Combat soldiers survive horrific things, and both witness carnage and cause it. But few of them expect to do so for 20-plus years, and of those few, fewer actually do. Paramedics, police officers and firefighters go to work, not war, and keep the peace, put things back together and go home, day after day. Their skin is thick, and they are experienced with the aftermath of sudden death – they have to be. The families of the victims need strong men and women to sort things out, and process the bodies of their loved ones. It is horrific work, but work that must be done. They will do their best, get through it and go home when they are through, but home will never be the same. Life for them will never be the same.

As for the rest of us? I guess the best we can do is understand that we will never be able to imagine what our colleagues are experiencing, unless it happens on our watch. I think we can prepare for it, train for it, do everything we can to be ready should it happen to us and hopefully make it through our time responding to emergencies without living through such a nightmare. The amazing thing is how many people take for granted that people like us will be available, and are surprised when one of us falls.

As for me, I’ll never make the mistake of thinking “I can imagine,” again.

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