Mass Casualty Exercise

I am posting some pictures of our recent MASS CASSUALTY exercise. This is performed several times while in theatre to make sure everyone that would actually be involved in a scenario like this is ready and knows their positions. This is not something that I have ever been involved with in the states so it was a learning experience. Essentially the number of patients and their ailments is decided and when the exercise begins, someone calls into the EMS saying that they have X amount of patients in this location, and they tell you what the hypothetical incident was. Our clinic is so small that when we have more than 2 critically wounded patients, we are considered to be having a "mass casualty". The incident they gave us this time was that there was a roll-over vehicle accident and there were 7 critically wounded and 2 dead on scene.
The dental officer...yeah, you would think I would be there to fix any broken teeth of people with minor injuries 3-5 days after the initial incident...NO SUCH LUCK!! The dental officer serves as the TRIAGE OFFICER during a mass casualty.
triage ( ) n. A process for sorting injured people into groups based on their need for or likely benefit from immediate medical treatment.
So now I get to be the first one in the whole medical clinic to see the injured!! Not what I signed up for!
I stand outside the clinic as they bring me these people, the EMS brief me on what there injuries are and their vitals, and then somehow I dig into my brain to decide if they are:

Black (Expectant) which entails pain medication only until death
Red (Immediate) which entails life threatening injuries
Yellow (Delayed) which entails non-life threatening injuries
Green: (Minor) which entails minor injuries

It is a bit like playing god (maybe not quite that important), which I have decided I would probably be pretty good at...except everyone would live. The hardest category to decide on is black. Essentially if I decide someone is black it means that they are likely to die OR that trying to save them would take away valuble resources that would best be used to treat patients more likely to live. Talk about a tough call. I guess that is why we practice these things?

I do triage in my real job, but when the worst outcome is the removal of a tooth...it sure does make it easier to decide.

So here is the team and a few of the pics from the exercise. Overall we did pretty good... we sat around a round table with a lot of important people a couple days later and discussed where we could make improvements. I had to get the "some people are going to die LT. Downey, that is what happens in a Mass Casualty" talk. :(

As promised I am posting pictures of my so called “camel-ride”. Turns out that there was only one camel when we got there, a large line, and the camel would be called BAMBI if it were a deer…so I decided not to ride it and just get a picture with it. The proportion of large people waiting to ride the camel was disturbing, so I figured one less time around the circle may spare him some bad knees!
Since I last blogged I have gone from super dead at the clinic, to really taking off here. The turn around came when I spoke to the Army PA that shares the clinic with us. I asked him if he thought his Commander would be open to the idea of me getting his soldiers in to the clinic, updating their exams and trying to get their work done before they go home in December. I had tried this with one of the other groups here and had not gotten a very good response… the kicker is that the non responsive unit only has 65 guys, whereas the other group has 600. They were responsive, and now I have been ramping up to almost a full time dentist here. It is great. They are a reserve unit and therefore have a lot of dental needs. These guys get activated, they are required to come in get an exam, get any EMERGENT care done, and then they deploy. Most of them still have a large amount of NON-EMERGENT dental care that goes undone. By the time they get home, they get another exam and then usually are not considered ACTIVE anymore so getting their dental work is done is on their own $. They have been really appreciative, and it has boosted my morale to know that I am getting utilized here.
Last weekend the Nurse (Lilly) and I discovered our Beauty Salon here on base. We had seen it before but were still in our US state of mind ….meaning, we thought EWW gross, it is probably nasty in there. But, after 2 months now, we have constantly been reorganizing our ideas of what is gross. We walked in and found 2 soldiers laughing, rubbing their eyes and couldn’t figure out what was going on. As it turns out, they were getting their eyebrows “threaded”. The chance of 2 females walking in on this are, I would guess 1/100, at this base. We could tell they were a little embarrassed, so Lilly decided to capitalize on this and says “What are you going to do if I tell your unit you guys were in here getting your eyebrows threaded?” and one answers back “ We were where?, what are you talking about?” He had his denial statement down. So I asked if they come here often and the one says “No Ma’am, our mission was canceled today because of the dust, so we were bored.” It was hilarious….two guys, mission canceled that were in the salon crying from how bad it hurt to get their eyebrow hairs in-line.
Last week we went to an outlying camp and saw the band Filter. It was a good show but I was forced to drink 2 "Near Beers", felt too strange to be at a concert without a beverage in my hand. It tastes pretty good to me. We also have wine called “Fre”, I guess that is a fancy way of spelling FREE (as in alcohol free), that tastes really good. We don’t have it at our camp so we get people to bring it back when they come from Arifjan.
My little guy that came in to get the ring removed from his lip (I say little cause he is adorable 18 year old that can’t weigh more than 110 lbs) was sitting out in the waiting room last week with a splint on his arm. Apparently he is the gunner on their missions which means he sits high in the middle with a strap on him and head poking out of the vehicle, anyway, he said they hit a big bump and he was holding on to the gun handles (takes both hands) and the bottom broke out underneath him sending him down into the cab, but he was strapped in up top so couldn’t fall all the way down. His shoulder dislocated from holding onto the gun when he hit the bump. The guys in the vehicle all had sound proof ear protection on and couldn’t hear him yelling or see that he was stuck. He traveled over half an hour with his arm pointing strait up out of the vehicle, arm dislocated before someone noticed his legs were flailing around. Although he got his arm back into the socket, he has some nerve damage. Poor kid.
This month is punctuated with a birthday party for Rausa, 2 fun runs, a haunted house, lower temperatures, and the promise that another month will indeed pass!!! Love and miss you all!