Duane D. Siberski, D.O., FACOEP-D, FACEP, PHP Media coverage of the latest mass casualty incident [MCI] has decreased.  Parkland High School is in the record book.  Remembrances of previous MCI events tribute the victims ceremoniously.  The Academy of Country Music awards show dedicated to the Route 91 victims, #RunBoston spelled out the city’s name with a course route along the city streets, a Massachusetts’s moment of silence at 2:49 PM occurred five years after the bombing, the National Park located at a plane crash site in Pennsylvania, the corollary New York City memorial and museum with a $44 admission ticket price, an empty field devoid of the removed Amish one room schoolhouse all stand as reminders to previous MCI events. American public sentiment and awareness ebbs and flows after MCIs occur. The need for an integrated system with well-trained providers responding to mass casualty incidents truly exists.  Critiques of MCIs bring to light shortcomings; communication failure, remote staging of [...]

Bernard Heilicser, D.O., M.S., FACEP, FACOEP-D In this issue of The Pulse we will review the dilemma presented in the April 2018 issue, referred to us by a frustrated paramedic. The situation involved a 70-year-old female patient being transferred from an urgent aid to an affiliated hospital emergency department. The patient had sustained a fall injury and struck her head.  She was on anticoagulant medication. The EMS crew noted the patient to be “a little restless …complaining of a headache”.  Although, initially alert with normal vital signs, she became disoriented.  The paramedic asked the physician if he would consider transferring the patient to a Trauma Center, concerned for a possible intracranial bleed.  The physician told him to run it by the accepting ED for medical control.  Diversion was denied. En route, the patient became nonverbal and responsive only to pain.  Diversion was again denied. The same crew was later called to transfer the patient to a different trauma center [...]

Bernard Heilicser, DO, MS, FACEP, FACOEP-D Medical Director & Medical Manager, IL-TFI USAR We often talk about decontamination as something accomplished prior to a patient arriving at our emergency department.  Fortunately, this is usually what occurs.  However, in our chaotic and disturbing world, we cannot always rely on this to have been adequately or fully performed, nor the probability of self-presenting patients from the scene.  Additionally, to be best, and safely, prepared, we truly need to know what is happening in the field, or our driveway, before we see the patient. With the multitude of dangerous chemicals traversing our highways and train tracks on a daily basis, the potential for hazardous material and other contaminants becoming clinical events cannot be overlooked.  The easy availability of these new weapons, by terrorists, adds to our concerns. Here is a brief overview of decontamination as practiced by trained responders at an operational level. If we define decontamination as the process of removing [...]

Michael P. Allswede DO “That music is going to keep me up all night.” Without realizing the irony of my words, I went to bed at 2100 on October 1st.  My phone started ringing around midnight with the words “every available physician report to Sunrise for a mass casualty event.”  I responded to Sunrise Hospital & Medical Center in Las Vegas for duty at 0020 and walked into one of the largest mass shooting events in our country.  My most enduring memory of that night was the strong smell of blood that permeated the ambulance entrance and throughout the emergency department. The Las Vegas mass casualty incident (MCI) began a bit after 2200 on October 1 at the Harvest Festival Concert.   The terrorist had planned his assault by reserving a room on the 32nd floor of a high-rise hotel with a view of the concert venue.  The terrorist had assembled an arsenal of 27 weapons with hundreds of rounds [...]

Janice Wachtler, BAE, CBA About 25 years ago, a television show premiered that focused on the daily activities of a group of physicians, nurses, and nurse’s aids in one emergency room in Chicago.  ER was a great hit for nearly 10 years and in one episode it chronicled one attending physician’s encounter with a patient’s family who accosted him and left him broken and bleeding. Recently, a nurse at a hospital in Chicago was shot and wounded by a patient’s family member who felt she did not provide that patient appropriate care.  The article in the Chicago Tribune called the emergency department a war zone, in which emergency department workers were often spat upon, accosted, and verbally or physically abused.  The wounding of this nurse was just the tip of the iceberg at this hospital. So, is it time for all the emergency medicine associations to come together and insist that emergency department personal be better protected?  Should we [...]