EMS

KN, p. 87 “How many bodies at the scene?”

 

 

(WARNING: Some photos may be disturbing to some viewers)

 

Not long ago, Sheila and I spent a pretty intense afternoon with a group of students and professionals doing a simulation of an explosion and its aftermath at a local campus. Here’s how it played out.

“You have reached 911. What’s the nature of your emergency?”

 

“A bomb just went off at the campus! There must be a dozen people hurt…there’s blood everywhere…”

 

Someone – a fellow student or perhaps a passing motorist – had called 911 and while sobbing or yelling the words into the phone, had begun the process to get help to the scene. The caller was kept on the phone in order to get any “who, what and where” details they might have known.

 

The 911 dispatcher made the appropriate call and told the First Responder, “There’s a possible explosion at the college. There may be multiple injuries.”

 

In general throughout the USA, the groups that respond will be from the Police/Sheriff, Fire, and Emergency Medical Services (EMS) Departments in the area. The unit that responds first is the First Responder and it is their responsibility to secure the scene. When the Law Enforcement agency arrives, they will determine if they are looking at a crime scene or whether something has accidentally exploded. In both cases, a perimeter is established.

 

If it is a crime scene, then access inside the perimeter will be limited to essential personnel and a sign in/out log will be used. An officer will guard the access point as long as is needed. This insures that evidence can be preserved as much as possible and that curious onlookers will not get in the way of either treatment of the victims or investigation of the scene.

 

Multiple victims, multiple injuries, an explosion and several agencies involved? How do they keep from tripping over each other? How do they know what to do next?

 

Each of the groups has a Command person in charge of that group. In addition, an Incident Commander is in charge of the entire scene, coordinating the efforts of everybody concerned.

 

 

 

Victims are prioritized by type of wound, and then tagged with a card that identifies the level of injury, before they are eligible for transport. In general, the tag colors indicate:

 

*Black tags – not breathing

*Red tags – will die if not treated immediately, but still breathing on own

*Yellow tags – broken bones, but alert

 

The ones having sustained the most serious injuries and who have the greatest likelihood of survival, are treated and transported first by EMS Transport Command.

Other victims who have superficial cuts and abrasions are treated at the scene and released from care.

 

One of the simulation victims had a piece of glass ‘stuck’ in her arm as a result of being too close to windows that shattered during the explosion. The EMS gal treating her explained that the glass would keep the wound from bleeding until the victim reached the hospital. Basically, it was plugging the hole in her arm. If the police considered the glass a piece of evidence, it would be collected, bagged and tagged at the hospital. The piece of glass would only be removed at the scene if the patient could not breathe or if it got in the way of doing CPR. Since the glass was in her arm, it was left there and bandages were wrapped around it.

 

The Incident Commander explained that the first priority was the treatment of the patients and that all evidence on (or in) the victims would be collected later at the hospital. The EMS does not remove anything from the scene if they can help it.

 

The police began to take statements from the witnesses after treatment was in progress, but prioritized the questioning – least hurt, most alert, were questioned first. The EMS people are under HIIPA rules, so are not allowed to share any information they see or gather from the victims being treated. The police have to get that info on their own. At some point, the law enforcement officers would obtain an order for medical records of the person who caused the explosion.

 

Sadly, one of the victims ‘died’ during the simulation, as would happen in real life. This lady did not make it because her injuries were so severe. (only a simulation – that’s a great makeup job)

If all this were really happening, area airports and highways would be shut down until the threat level was determined. Was it an accident in a lab? Or was it a terrorist action? Unless the investigators get lucky and somebody confesses or does the ‘big reveal’ right at the scene, the truth is, that at an hour after the initial explosion, all that is known for sure is that lots of people have been hurt.

 

Sheila and I were impressed with how well the simulation went and how well organized it was. Great experience for us to see how a well-trained group can bring sanity to a potentially chaotic situation.

 

 

 

*Photos taken by Patti Phillips at a real simulation conducted in Guilford County, NC at the Writers’ Police Academy.

*Sheila and Charlie Kerrian are fictional characters, but the simulation actually took place.

 

 

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KN, p. 189 “Fifth Anniversary Thank You from the Kerrians”

 

Kerriansnotebook_FINAL copy

It’s with great pleasure that we thank you, the readers, for hanging out with us for five years.

 

We’ve taken some really amazing trips to American Civil War battlefields, endured fog and pouring rain on both American and international golf courses, been trapped in elevators, survived bomb scares, witnessed bloody crime scenes, and lived to tell the tales.

 

Some intriguing people have agreed to do interviews about their jobs and in the process, have opened the eyes of our readers far and wide about the rigors of law enforcement in its many forms.

 

Police Academies, Fire Fighter Academies, Emergency Medical Training Schools, Firearms Training sites, Criminal Investigation Facilities –  have all generously allowed us to take photos and chat with the instructors at length. Fascinating stuff.

 

We’ve met with Visiting Detectives – an assortment that included a psychic detective, a vegetarian detective, and a time-traveling detective from the 1800s. Sheila chimed in while they worked on puzzling cases with me. The Vegetarian Detective brought brownies. Yum.

 

Kerrian’s Notebook, Volume 1, which included stories from 2011 and 2012 no longer available on the website, was published in response to the readership that wanted the (over 50) stories from the first year collected into one ebook. Don’t have your copy yet? Click on the link and find it at Amazon: http://www.amazon.com/dp/B00HI6YBDG

 

You’ve made the journey fun. And then some.  🙂

During the years, we kept track of which posts were the most popular, which ones you kept visiting over and over again. For research? For another laugh? To prove a point? For some of you, all three. Here is the result.

 

Click on the links and take a look at your Top 10 Favorite Kerrian’s Notebook posts in reverse order thru 2016:

 

  1. Who are the Texas Rangers?” (p.144)

 

  1. Are all handcuffs yellow?” (p.68)

 

  1. What does a Texas Ranger do?” (p.145)

 

  1. How big is that jail cell?” (p.51)

 

  1. Kerrian’s Favorite Chocolate Cheesecake.” (p.45)

 

  1. 100 Ways to Die an Unnatural Death.” (p.100)

 

  1. What does a firefighter wear?” (p.119)

 

  1. I Like Pie.” (p.67)

 

  1. How many bodies at the scene?” (p.87)

 

And the most popular post?


  1. How to become a Texas Ranger.” (p.146)

 

Thank you, one and all!  🙂
Next time you’re in town, give us a call. We’re always happy to chat about the latest trip or the trickiest case. If you’re lucky, you might even meet one of the Visiting Detectives. There’s always a pot of coffee on and a piece of pie just begging to be eaten.

 

*Fingerprint photo taken by Patti Phillips at SIRCHIE, in Youngsville, North Carolina.

 

 

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KN, p. 180 “What happens in the ambulance?”

 

What Happens in the Ambulance

We’ve been seeing quite a few ambulances in the neighborhood lately. It’s human nature to wonder who is sick or hurt and to see more than one a week at certain houses is more than a little worrying. We are lucky enough to live within four miles of the hospital, so response time is pretty quick – 7-8 minutes from the time the call is made to get help. But, we have two Senior citizens living close by and sadly, the sirens have been blaring every few days. A couple of times, the crisis was managed at the house and other times, our old friends made the trips to the hospital.

 

What does a paramedic actually do? Suppose the patient is not at home, surrounded by friends and family?

 

The paramedics are responsible for pre-hospital care. They do all they can to keep the patient alive until the person can be seen by a doctor. They cannot act on their own, however. After hearing the patient’s Vital Sign numbers, the Emergency Room doctor at a health care facility (usually the closest hospital) gives orders to the paramedic via phone or other device about the procedure to follow. This is no easy task, because the EMTs/paramedics must communicate not just the numbers, but also the state of the patient’s appearance and what may have caused the problem to begin with. A medical history isn’t always available (as at an accident scene), and the reason for a sudden loss of breath sounds or heart beating may not be apparent.


What Happens in the Ambulance

A paramedic’s first job is to keep the patient alive, and that may mean getting the heart started again, getting breathing going again, and/or stopping blood loss.

 

There are protocols to follow.

 

One person is in charge of the case at the time. He/she delegates the jobs for the rest of the team to carry out.

 

It is a two person job to clear the airways, monitor the patient’s vitals and administer whatever drugs are necessary to get breathing started.

 

If the heart has stopped, there is a mathematical procedure to follow: 32 chest compressions followed by two breaths, with the team switching positions every five minutes. Ever try to do this? It’s not easy to keep the compressions going for five full minutes. They must continue the process until the heart beats on its own or until the ambulance reaches the hospital. They keep “working on the code.” If they can get started on the chest compressions within three minutes, then there is a greater likelihood that oxygen will get restored to the brain.

 

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But, that’s not all that is happening on the ride to the hospital. Blood sugar and other levels are checked while in transport. These days, an ambulance is a mobile intensive care unit. It’s the paramedics’ lab. Tablets are proving to be invaluable, because they can deliver more information to the doctor – including cardiac readings – and then the doctor can make more informed decisions about the transit care.

 

Ever take a ride in an ambulance when you weren’t a patient? I got to do that once and I was surprised to find out that the siren wasn’t nearly as loud when we were sitting inside. I also discovered how much bouncing goes on in the back of the ambulance. Roads are not as smooth as you might think and some neighborhoods have speed bumps installed that slow down the ride considerably. But, one of the guys revealed that they train while the ambulance is moving – including inserting lines for fluids! They anticipate the normal bumps and rocking that occurs and develop a rhythm for doing their jobs. A bit like getting used to working at sea.

 

Because there may be a shortage of doctors available to give medical orders (they may be busy with another patient from an accident, or another heart attack victim) some regions of the country now have paramedics that are so highly trained that they can work under a doctor’s license without contacting a hospital. This requires special certification – not every paramedic is allowed to do this.

 

The average pay for paramedics is a little over $40,000 a year. What kind of training is needed? The first step is Emergency Medical Technician (EMT) training – about 150 hours (9 weeks). After passing certification tests and working in the field for at least six months, then the candidates become eligible to attend Paramedics school – an additional 1200-1800 hours of training (perhaps two years). Then, you can work in a fire station, in a hospital, or anywhere that employs a paramedic – even at a resort. Of course, you have to be able to lift sick and injured people, have a stomach for working with broken bones, nauseous patients, and bloody accident scenes. Think you can do that? It’s a rewarding career if you can.

 

A related article shows what an EMT might do at the scene of an explosion, before the patient ever gets into the ambulance. The event was a simulation, but the pictures may be too intense for some people. Click here to read “How many bodies at the scene?”

 

 

*Photos by Patti Phillips

 

 

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