Mass Casualty Incidents and Trauma Response

Mass casualty incidents (MCIs) have unfortunately become a more frequent reality. In this episode of The Erik and Matt Show, Dr. Erik Axene and Matt Ball reflect on the tragic New Orleans attack that left 15 dead and dozens injured. They dive into the principles of effective MCI response, emphasizing the importance of triage, hemorrhage control, and teamwork. Whether you're an EMT, paramedic, or simply looking to understand the challenges first responders face, this episode is packed with actionable insights.

Transcript

Matt: [00:00:00] Yeah. It just always amazes me when you think about one minute you go from kickback in the recliner, you know, letting your dinner settle, watching a movie to you’re treating a hundred gunshot victims at a mass shooting.

Narrator: You are listening to EMS with your hosts, Erik Axene and Matt Ball.

Erik: Happy New Year. Happy New Year, man. It’s been a while since we’ve, yeah, we took a break.

Matt: [00:00:30] Yeah. Took a nice holiday break. Do you have a good Christmas and all that stuff? Yeah.

Erik: I did. What’d Santa bring you?

Matt: Uh, what did I get? Uh Some clothes.

Clothes. Yeah, me too. Clothes. Clothes. Yeah. Clothes. That’s about it. Yeah. Nothing exciting. Yeah. Nothing. I mean, when you get to be our age, just making it to the next Christmas is exciting. So.

Erik: Speak for yourself. Yeah.

Matt: Well, but over New Year’s, I had some exciting events. We’re about to [00:01:00] do a hemorrhage lecture.

We’ve been working on a hemorrhage lecture that we’re excited about, but there was a I mean, they’re now calling it a terrorist attack that happened in New Orleans.

Erik: Terrible. It really is terrible.

Matt: Absolutely terrible. Tragic. Super tragic. And it just kind of brings to mind, you know, um, trauma, mass casualty incidents.

Unfortunately, these are becoming more and more commonplace in our nation.

Erik: Whether it’s a shooting or a truck into a crowd.

Matt: Yeah.

Erik: Natural [00:01:30] disasters.

Matt: Yeah, these mass, mass casualty incidents where you have lots of victims. I think, what was the last time we looked, there was 15?

Erik: 15 dead and 35 injured, I think.

Matt: Yeah, in New Orleans. So, it’s, uh, you know, these are incidents that, you know, it always amazes me how you’re, you’re sitting around the firehouse or wherever, and you just never know what the next call’s gonna be. You know, it might be a poo poo pain at the nursing home, it might be grandma fell out of [00:02:00] bed, or it might be a truck just, you know, drove through a crowd of thousands of people.

And it’s, you know, now it’s, it’s the call.

Erik: And it’s the same way in the ER. I never know what ambulance call I’m going to get, I don’t know what trauma is going to come in, or who’s going to bang on the ambulance doors. Those are always some of the sickest patients that you see. And they’re amazing. It’s amazing how, how sick somebody could be walking in too.

Matt: Yeah.

Erik: Yeah.

Matt: It’s, yeah, it just always amazes me when you think about [00:02:30] one minute you go from kickback in the recliner, you know, letting your dinner settle, watching a movie, to you’re treating, a hundred gunshot victims at a mass shooting. I mean, God forbid that happens, but it does happen and we have to be prepared for it to happen.

And again, that’s why we always talk about education is so important because these are once in a career calls. I mean, I’ve been in the fire service 20 years. Yeah, I’ve had my fair share of gunshot victims. [00:03:00] Most of those have been, unfortunately, self inflicted. Um, you know, I’ve had some, certainly some, some, uh, gunshot victims that weren’t self inflicted wounds.

But it’s rare. You know, unless you work in a major urban area, going on a lot of trauma, gunshot victims, stabbings, things like that, it’s not very common.

Erik: Yeah, that’s right. I used to work at a level one trauma center in a state not too far from here.

Matt: Yeah.

Erik: And, uh, we, we were a catchment area for the whole state.

Yeah. And it was, uh, we saw a lot of trauma. [00:03:30] Some of the, the institutions I’ve trained at, too, just, just a lot of trauma. It can be so much different in the rural setting versus the urban. Yeah. It’s, but, but the pathophysiology is all the same, you know, the, the, with a truck hitting a group of people, um, you know, uh, it’s not uncommon in our ER to see somebody who was hit by a car, not common to have, 35 people hit by a car.

Yes.

Matt: All coming in within an hour.

Erik: Yes. Yeah. And so it [00:04:00] really can overrun, which is the definition of an MCI, but it will overrun your EMS system.

Matt: And yeah, I think that’s important to talk about is, I mean, if you’re a one ambulance department, you could have a bad wreck on a county road and have three critical patients.

That’s an MCI to your agency.

Erik: Yeah. You

Matt: know, because it is overloading what you have available to you. So you know, obviously New Orleans, you know, we met the folks from New Orleans EMS, great folks. They’ve got a good system down there, their fire department, New Orleans [00:04:30] EMS, sure that they were well prepared for an event like this.

Erik: Yeah, being prepared, that’s a key, right? I mean, what types of injuries would you see with, uh, I don’t know specifically what they saw there on Bourbon Street. I think it was on Bourbon. But, you know, it could have been a blunt trauma. For sure, blunt

Matt: traumas.

Erik: You could have had massive internal bleeding.

Head injuries. Extremity fractures, crush injuries, crush injuries, driven over

Matt: potentially.

Erik: Yep. Uh, of the 15 people that died, uh, you know, [00:05:00] having a, being very comfortable with the triage system too is important. That’s right.

Matt: Yeah. You’re starting, whatever, everybody uses a little bit different system, but the, the point is, is that if you are the first folks on that scene, your job is not to treat your job is to identify.

Who are the Blacks? Who are the patients that are not going to survive this? And because what is our end goal in these MCIs? Our end goal is to save the most amount of people possible, [00:05:30] right? And to do that, we have to be really good at triage.

Erik: So

Matt: that we know the ones that aren’t savable, which in a On a regular call, we would work those patients.

In these situations, we don’t have the resources to work every one of these patients.

Erik: Because you’ll lose other people than yourself.

Matt: Exactly. You’re going to spend all these resources on somebody that’s probably not going to live, and ten other people die because of it. That’s why we have to do this.

Erik: And

Matt: I’ve never worked a real MCI like this.

I can only imagine that’s a really difficult thing to do, to walk past [00:06:00] somebody who typically you would stay and work on, to go and help other people, you know, but yeah, your initial goal is to triage and identify who are my blacks, who are my greens, who are my yellows, who are my reds, you know, the greens, you know, everybody learns that in classes.

Hey, if you can hear my voice, come follow me and you get those people if they can walk in their ambulatory. They’re probably not going to die within the next hour. Move them. Now, one thing to remember about MCI is that their colors can change. They might be a green initially [00:06:30] and they might progress to a yellow or a red.

Erik: Right.

Matt: Right. So we’re constantly reassessing, but yeah, difficult situations for sure.

Erik: It’s a paradigm shift too. I know when the Spanish flu hit 100 years ago,

Matt: were you there?

Erik: Yeah, it was not that old, but there’s a reverse triage even back then. It’s like they, you don’t have the resources to treat like you do typically in the ER.

Uh, the sickest patient in the hospital, the sickest patient in the ER is going to, [00:07:00] um, is going to utilize most of the resources at that moment, right? That’s right. We’ve got that cardiac arrest, the guy that coded in room two, and we’ll all come in and work our hardest on the sickest. In a triage MCI situation, the sickest, or maybe the ones that are already dead, or whatever, you don’t, you don’t, you don’t work that, you don’t, you can’t.

And, uh, because, and that’s again, when you have other bystanders there, that they’re not going to understand that, you know, why aren’t they [00:07:30] taking care of this? Right. Uh, or even checking this guy. Yeah. What if he’s not dead? Yeah. You know, there’s, there’s a, a reverse triage mentality that we have to be really good at, and it’s difficult.

Matt: Yeah, the other thing I think we have to be really good at in these situations is doing those skills that we don’t often do, right? I mean, tourniquet placement, we should be practicing with those a lot, but when somebody’s bleeding out of their femoral artery, you better be pretty proficient at putting on a [00:08:00] tourniquet or two.

Erik: Or two.

Matt: Yeah, you’re not going to have time to be like, oh, what’s this? You know, you have to practice with those things. Where is the bleed? Right, go high and tight artery. Where’s the

Erik: tourniquet?

Matt: Right? Yes. Yeah, exactly. Where? Yeah. Knowing where your equipment is. That’s it’s funny, but it’s not funny because it’s super important.

You got to know your bags. You got to know where your equipment is throwing a chest seal on throwing in an N. P. A. And O. P. A. Doing thing. Needle decompression, where to do it, how to identify those landmarks. If you’re critical care and you’re doing [00:08:30] finger thoracostomies, because we’re talking about blunt trauma, um, you’re probably not going to be doing a pericardial synthesis in a mass casualty situation.

But, um, these skills are skills that you have to be able to quickly identify. Number one, this is what the patient needs. Knowing where that equipment is and knowing how to do it. Super, super important.

Erik: Yeah, part of the, I think the underappreciated part of it is the assessment. Identifying the [00:09:00] pathophysiology, identifying the disease, and then knowing how to treat

Matt: it.

Do they need a needle decompression? Like, are they showing signs of a tension pneumo?

Erik: You

Matt: know, do they really need me to do this right now? Yeah, do they need a tourniquet? I mean, you know, I’ve seen A lot of times these videos that you see online, people just throwing tourniquets on, and is it probably going to have a bad outcome?

No, it’s probably not if there’s a gunshot wound or something, but you know, if you watch our hemorrhage lecture that we’re going to talk about, we go into much more detail about when to put on [00:09:30] tourniquets, you know, what to look for, things like

Erik: some of the signs of hemorrhagic shock,

Matt: but head injuries.

You know, I’m sure that there was probably multiple head injuries with this guy blasting through in a truck. Uh, the videos are pretty hard to watch. It’s scary thinking, I mean, that’s a 6, 7, 000 pound missile coming at shit. However fast he was going. Some of the

Erik: video footage I saw, I mean, really, really fast.

Oh yeah, he’s

Matt: moving.

Erik: He’s moving fast.

Matt: Yeah.

Erik: Yeah, for sure. Head injuries, blunt trauma, chest, abdominal [00:10:00] trauma, internal hemorrhage. Bleeding, internal bleeding,

Matt: yep.

Erik: Uh, potential vascular injuries in the extremity, needing a tourniquet potentially, crush injuries, which cause a whole other group of problems down the line.

That’s right. Uh, you know, uh, and then there’s also, you know, airway emergencies too, right? Yeah. That’s always a concern.

Matt: Absolutely.

Erik: Anytime you have massive injuries, you’ve got to think about airway support.

Matt: I think it’s important to talk really quick about, and again, we talk way more about this in our lecture, but what are the three, what’s the trauma?

[00:10:30] Triangle, right? That we always talk

Erik: about the danger. Try it. Yeah, yeah, yeah,

Matt: exactly.

Erik: Hypothermia.

Matt: Hypothermia. That’s one that we, I, when I’m teaching, especially here in Texas, we don’t think about it because it might be a summer day here in Texas and it’s 100 degrees outside. And what do we have going in the back of the ambulance?

We got that AC cranking, right? You’re a big guy. You’re hot natured. We get in back. We’re stressed. We’re working. We’re dumping sweat and we forget. Yeah, but your patient is losing volume, [00:11:00] which means their temperature is dropping

Erik: and

Matt: we don’t think about, Oh, they get a little bit cold. They’ll be fine. No, no.

That is a huge factor. We’ve got to keep these trauma patients. Which is related

Erik: to hypercoagulability. Exactly. I think the, uh, that’s another part of the, the, the triad and then of course, acidosis. Acidosis. That’s

Matt: right. Yeah. And they’re losing blood and I think it’s. It’s crucial, because I still see people doing this.

When I went through paramedic school, it was two large bore IVs and give them a bunch of fluids. That’s [00:11:30] not helping these patients. As a matter of fact, it’s killing these patients. You’re pouring this fluid that does not have hemoglobin, does not carry oxygen, which is Go ahead.

Erik: Oh, yeah, you’re making the bleeding problem worse.

Yes, you’re making You’re adding water to a liquid that can coagulate and stop bleeding. You’re blowing

Matt: the

Erik: clots. You’re making it more dilute. That’s right. You’re also based on literature. We’ve learned and we’ve talked about in our lectures is you’re making the blood vessels more permeable to them.

That’s right. [00:12:00] They leak more. That’s right. So you’re making a leaky vessels. Yes. So you got to be really careful with fluids. That’s not the answer. We want to replace what we lost. That’s right.

Matt: And define that because that there could be some confusion when you make that statement.

Erik: So when you bleed out 40 percent of your blood onto the asphalt.

Yes.

Matt: I was bleeding out my own blood

Erik: five minutes before this all happened. Everything was fine and Dandy. Your heart, your pumps, fine. Your blood vessels are [00:12:30] fine. Everything’s fine. Blood pressure vitals are fine. And then you have some sort of an insult and you lose a bunch of blood on to the pavement.

So the problem was the blood on the pavement. That’s right. So we want to solve that problem that gets the blood back in? That’s right. The

Matt: blood back in. Yes, yeah.

Erik: So. You could, you couldn’t, um, again, we talk about this in the lecture, but this is important to understand is that, you know, you’re, uh, you could bleed every bit of blood out of your body for one drop, your hemoglobin never [00:13:00] changed.

It’s a concentration. I know it’s a blood value that we don’t check in the ambulance. The key is Well, but the critical care folks can. The critical care, yeah, so the average hemoglobin of a man may, mine might be 14 or 15. I

Matt: just go with 15 across the board.

Erik: 15 15 for

Matt: male

Erik: and female. If you’re on testosterone, you might be at 22.

Right, but that’s,

Matt: yeah,

Erik: yeah, right. Or COPD, right? Yeah. Polycythemia. Yeah. But, you know, but my hemoglobin is probably around 14 or 15. Right. I’m guessing. I think for, for women it’s typically a little bit lower. Yeah. For men it’s typically a little bit higher. Yeah. But [00:13:30] that’s a concentration. Yeah. So if I were to measure my hemoglobin right now, I’m going to measure my hemoglobin.

All right, it’s about 15, right? Now I’m going to take a bucket and I’m going to bleed everything out of my body, except for one drop. Your hemoglobin. A lot of times people will think, well, your hemoglobin is really, really low now.

Matt: Yeah. No, still 15 still 15. Yeah,

Erik: it’s a concentration. I just don’t have much of it.

It’s a volume problem. I need to get that blood back in. That’s right. Acutely. Now, chronically, my hemoglobin can fall because I’m bleeding slowly [00:14:00] and my kidneys will respond by reabsorbing more fluid to maintain volume. But what happens, though, is my blood becomes more dilute. That’s right. And as my blood becomes more dilute, my hemoglobin concentration goes down and down and down.

If I slam a bunch of blood on somebody that’s chronically lost blood over time, I could kill my patient. That’s right. By giving them too much blood and volume overloading their pumps, especially if they have heart disease. It’s a really interesting difference between chronic blood loss and acute blood loss.

That’s right. When you’re hit by a [00:14:30] truck. And, and you’re losing blood onto the pavement in a matter of seconds. Yes. You go into hemorrhagic shock quickly because of blood loss. That’s right. Way to fix it is to give them the blood back. That’s right. Fluids can make it worse. That’s right. Too much fluids.

Yeah.

Matt: I mean, a little bit, you got to have a little bit of volume. And if that’s all you carry, you know, so I think, you know, looking at this from a provider level. Not to, but EMTs, obviously most EMTs can’t, don’t start IVs.

Erik: So

Matt: the [00:15:00] crucial thing is to stop the bleeding.

Erik: Right.

Matt: And in all of these cases, whether you’re an EMT, a paramedic, or a critical care paramedic, the point is, we can’t fix this in the field.

Erik: Right.

Matt: We have got to get these patients to a trauma facility. Correct. We’ve got to get them to a doctor. We’ve got to get them to a trauma surgeon. Quickly. So, EMTs. Stop that bleeding however you can. Pressure, tourniquets, whatever you can do, get them in the back and go. Paramedics, you can [00:15:30] do some more things, but don’t waste a ton of time on the scene doing these things.

You can be doing those things in route, even the critical care folks, you know, don’t stay in play. This is the time to load and go. That’s right. That’s right. You can do a lot of these things in route. Sorry. I interrupted you. What were you going to say?

Erik: No, this is, this is a, this is actually pretty controversial because there are a lot of departments across the country who presented with a case, person hit with a, by a truck.

Required two tourniquets to stop a massive bleed, blood all over the asphalt. [00:16:00] Blood pressure is 80 over 40. This guy needs fluids.

Matt: No.

Erik: Slam a liter. No, we don’t do that. That is hypotension. That’s exactly right. Yeah. Permissive hypotension. In fact, I talked to a trauma surgeon that I work with. We were treating a very sick patient.

In fact, one of the sickest patients I’ve ever treated. Uh, involved a car fire and massive deceleration into a bridge pillar and, uh, I remember you. We’ve talked about this. Thoracotomy. Yeah. for chest. I mean, this guy was sick, right? I was talking to my trauma [00:16:30] surgeon a little bit as this patient was getting shipped off to the O.

R. And, you know, I would much he’s saying I would, I would be so happy if a trauma patient comes in with a blood pressure of 70 over 40. Right? Yeah. Um, you know, I think one of the important things and just don’t just focus on the numbers. You see a low blood pressure, but you’ve stopped all bleeding. Well, yeah.

From what you can tell, you’ve stopped bleeding maybe in an extremity or whatever it was. Right. And you’re talking to the patient [00:17:00] constant reassessment. The sicker your patient is, the more often you should be reassessing. Wow. The metal, metal status is declining. Yeah. There must be something else going on.

Matt: What’s, what’s, yeah. What else is bleeding?

Erik: And if all you have is fluids and you know, you may have to give some fluids,

Matt: right? Or pressors might be helpful depending on what kind of pressors you have. All protocols,

Erik: right? Yep. Um, yeah, I think, I think that the path of physiology, though, of a young person who was hit hard by a car or maybe there was some sort of an injury of some kind, a [00:17:30] car accident, let’s just use that as an example, maybe a shark bite, right?

Yeah. The injury of these shark bites that we studied in our lecture that we just filmed is, is really about hose damage. Yeah, the pump’s fine. That’s right. The pump is fine. Yes, it’s the hoses that got torn up and we’re losing fluid out of these hoses. We can understand that

Matt: an easy way to remember.

We’ve said it before. Is it a pump problem? Is it a hose problem or is it a fluid problem? Right. Right. If you’re losing blood, that’s a fluid problem. You’re pumping your hoses or well, one of your hoses got [00:18:00] busted, which is why you lost the fluid. Right. But you got to stop clamp off that hose and then replace what you lost.

Right. If it’s a pump problem, that’s probably not going to be a trauma related thing. That’s going to be a medical related thing. So when you’re thinking about it, As a paramedic, like, okay, the heart’s probably fine, especially if you’re dealing with a 25 year old trauma patient,

Erik: right?

Matt: The pump is fine.

Erik: Most of the people hit by that truck were probably youngish.

Matt: I’m

Erik: sure.

Matt: Yeah. There’s probably not a lot of 80 year olds that were party on Bourbon Street. I mean, I’m sure there was one or two, you know, go have fun. [00:18:30] Right. You do you, but you’re right. You have to look at that. And we can’t look at things the same.

It’s like working a trauma arrest. I remember teaching when we started to make a shift of I mean, and we’ve talked about this before, beating into people’s head, chest compressions, chest compressions, chest compressions, and then we go into trauma arrest, it’s like, hold on the chest compressions, let’s address what the, what the trauma was first, let’s do skills first, whether that’s needle decompression, [00:19:00] finger thoracostomies, pericardial synthesis, you know, whatever the case may be, let’s address that first, and not do chest compressions, and I was teaching that at departments, and guys were losing their minds, like, Are you telling me I’m not supposed to do chest compressions in a patient of cardiac arrest?

And I’m saying, I’m not telling you not to, I’m telling you that’s not your number one priority because we have to think about the pathophysiology of what’s going on. If your pump on your fire truck, if you have not [00:19:30] hooked up to a hydrant yet, and you have run out of tank water, is it a smart idea to crank up your pump?

No, you’re going to cavitate your pump.

Erik: You

Matt: got to fill that tank back up before you can turn your pump back on. Well, if you go jumping on the chest of a trauma patient, you’re just pumping out every little bit of volume they have left. It’s not saving their lives. And we just, again, we don’t do this enough.

Again, I mean, I’m sure if you work in a large urban area, you’re running a lot of trauma or if you work in a trauma facility, you’re working a lot of [00:20:00] trauma. But for those folks working in like suburban departments and things like that, we run way more medical than we do trauma. And it’s two totally different pathophysiologies and we have to understand

Erik: that.

The vast majority of people in cardiac arrest that are older with comorbidities. It’s a pump problem. That’s typically what it is. A younger person in the context of trauma, it’s a hose problem. That’s right. It’s a hose problem. The pump is fine.

Matt: That’s right.

Erik: Typically. There are some exceptions and we have to be careful.

Yeah,

Matt: nothing’s definitive. [00:20:30] Nothing’s 100%.

Erik: A great, here’s a great story that kind of illustrates this. I think really a 19 year old kid, uh, was walking across the street, hit by a car.

Matt: Okay.

Erik: Massive injuries. Um, and, uh, he, uh, had injuries and there’s some extremity injuries, uh, one required, one extremity required a tourniquet, um, just, just bones in a bag.

I mean, the leg was just munched up. Yeah. And, uh, the patient came in, they were doing chest compressions because they couldn’t find pulses [00:21:00] and, you know, pulseless patient equals chest compressions is the mantra typically. But in the context of trauma, now the evidence isn’t. I mean, we follow your protocols, but it, I, it’s, I think we’re causing harm in certain situations by doing chest compressions where these people don’t have a pump problem.

Why is pressing on the chest doing any good when the problem has to, it’s down the line and they don’t have their, but they don’t have

Matt: a heart rate. They don’t have a heartbeat.

Erik: And why not? Why not? Why don’t you feel pulses? Why didn’t [00:21:30] that 19 year old have pulses?

Matt: Well, more than likely is because his volume was so low that the pump was working fine.

But it’s like, again, thinking your fire truck, if you have no volume coming out of your pump, what are you going to have at the end of your hose line? You’re not going to have zero pressure for pulse. I don’t feel

Erik: pulse to start that. That’s right. Right. That’s right. There is actually a pulse there. You just couldn’t feel it because the cardiac output was so low.

Some, not all the time, but typically in a young person with a traumatic mechanism. Be very careful with these [00:22:00] things.

Matt: Look for other signs. If you have ability to do ultrasound, ultrasound the heart, see if there’s motion. Um, you can do other things to see if they’re actually flowing blood, you know, you can look at other things.

Erik: So let me finish my story now. Oh, sorry. No, that’s okay. It’s just really good to talk about it. So this 19 year old with all these injuries or whatever, chest compressions, right. Couldn’t get a pulse back. I mean, couldn’t get a pulse back. Pulse never left actually, in my opinion. But as soon as we got blood, As soon as we got blood in his tank, blood [00:22:30] pressure’s there.

Was he in PEA? Pulses are strong. Pardon? Was he in PEA on the monitor? Yes. Okay, so they saw the rhythm. It was rhythm. If you’re an asystole in a traumatic situation, that’s a totally different ball of wax. Just double checking. But this patient, yeah, so we see electrical activity. Um, you know, as we’re doing chest compressions, they brought in, doing chest compressions.

And, uh, as soon as I got that massive transfuser, putting blood in this guy, immediately the blood pressure is back. He’s got pulses. Unfortunately, he didn’t survive, but, um, it was [00:23:00] clear to me what was going on. Yeah. Had massive hose problems.

Matt: Yeah.

Erik: Unable to perfuse his organs. That’s right. Um,

Matt: yeah. And another thing, you know, we talked about permissive hypotension.

You know, you, you look at the map, which, you know, most EMTs or paramedics, you know, they don’t really learn a lot about the map. You know, the mean arterial pressure and basically all that means is what is the point of the blood? It’s to keep the ma the organs alive. Right. Profu, profused. Right. Keep the brain profused.

Mm-hmm . Really like I was, we were just talking about this the other day. We’re not [00:23:30] doing chest compressions in a cardiac arrest situation to keep the heart alive. We’re keeping the brain alive.

Erik: That’s what we’re trying to do. Brain cells, very hungry for blood. That’s right. Need the sugar, need the oxygen.

Exactly. You stop a brain cell, it’s going to die and swell.

Matt: We’ve all seen it where we give enough epi or we shock enough times that we get a pulse back. But the brain, noxic brain injury, right? They were taken off the vent. Right. So we’re, our goal is these patients to survive and walk out of the hospital.

Right. So we talked about permissive hypotension. If you look [00:24:00] at that map, which if you, most of your monitors, it should be a small number right next to your blood pressure. And there’s some

Erik: two thirds diastolic, That tends to be a little closer to the diastolic number.

Matt: Correct. And you know, so, you know, in hospitals, 60, 65, you know, typically, but I’ve even, some

Erik: say 70, exactly.

Some, I’ve

Matt: heard trauma people say 35 to 40. In a life threatening situation is enough to keep things alive to get them to, you know, so there’s, you hear people say [00:24:30] all different kinds of things, but again, your blood pressure doesn’t have to be one 20 over 80, you know, just remember that as a provider that if their blood pressures, you know, 90 over whatever.

That’s okay. Keep it at that. Like you said, look at other things. What’s their skin color? What’s their mental status?

Erik: Mental status. When I get a call, an online medical control call in a situation like this, I’m going to ask, what’s the patient’s mental status? What’s their GCS? They’re talking to me. Well, keep them talking to you.

Get them to me. That’s right. 90 [00:25:00] over 50. Perfect. Keep talking to them. That’s right. If that changes, we may have to do something different. But for now, let’s keep Yeah. And we’re gonna get this, um, uh,

Matt: uh, uh, we’re gonna get this done. Um, and then we’re gonna, uh, we’re gonna get the IVs done. And then we’re gonna take them to the, uh, the, uh, the, uh, the,

Erik: uh, the hospital, as 250 cc’s of NS in these traumatic situations may not cause harm.

Matt: May not [00:25:30] cause harm. So it doesn’t

Erik: say it helps,

Matt: but it just might not hurt.

Erik: If you can

Matt: give blood, give blood.

Erik: In some situations it’s different, but in a traumatic, acute blood loss situation, you’d be very careful about what you do with fluids. That’s right. It’s not something to be taken lightly. It’s reflexively doing.

Right. In a trauma, okay. Bilateral large bore IV, slam a liter of fluid, go to the trauma center. That’s kind of the way, and still today, in a lot of places. Uh, so [00:26:00] we have to be careful. We gotta, we gotta change that paradigm.

Matt: I think the big takeaway is You know, these events, and it’s a sad thing to say, is that these, whether you want to call them terrorist attacks, whatever the case may be, these mass casualty incidents are becoming more frequent, and if you haven’t had one in your town, I hope that you never do, but the likelihood of you having some sort of a mass casualty incident is increasing.

They are not just happening in urban [00:26:30] areas, they’re happening all over the country, and so the big thing is that you need to be prepared. Yeah. You’ve got to do your homework. You’ve got to understand your mass casualty triage system. You’ve got to have equipment ready to go, know how to

Erik: use

Matt: it, know how to use it, know where it is, know how to use it, practice with it.

We do that numerous times in my department. Uh, we just recently came out with massive, a separate bag, trauma bags tourniquets, all these kinds of things. Everybody should be doing that’s a sad state of [00:27:00] affairs, but we can’t ignore the fact that these this is what’s happening You know, so I heard you know, great job to the New Orleans EMS folks.

They did the best they could under really bad And

Erik: I’m sure that the law enforcement folks are like this too, but I know out here they’re carrying tourniquets. I think everybody’s carrying tourniquets now. I think that’s pretty standard. Pretty standard. Which is not always. Typically only carrying one.

It’s not always been the case though. No. It’s not always been the case.

Matt: Definitely not. They’re typically only carrying one in their belt though. Um, but you know, and they’re getting more comfortable with using them. [00:27:30] A

Erik: lot has changed, and we talk about this in our lecture, with our military experience. Yes.

And then experience with the Boston bombing. Yep. I mean, I think I’d read only one conventional tourniquet was used. Yeah. Uh, so, we’ve learned a lot. Yep. And, uh, there’s more to learn. Yep. There’s more to learn. I’m

Matt: sure we’ll learn more from this last incident, too. Yeah,

Erik: I’m sure we will. So,

Matt: well, it’s an interesting topic.

And watch for our hemorrhage lecture. It’s a good one.

Erik: Yeah, and I think, again, it’s worth saying, uh, Just, uh, our thoughts [00:28:00] and prayers are with all the people involved and families affected by this. Absolutely. And

Matt: the first responders that had to see that stuff. The trauma of it. Absolutely. Yeah, police, EMS, everybody.

Yep. Terrible situation. See you on the next one.

Erik: See you on the next one.

Narrator: Thank you for listening to EMS, the Erik and Matt Show.