“Arrrghh!” I woke myself up with a shout, heart thudding. Outside my tent a raucous screech tolled the predawn hour, one nightmare blending into another. Today was the day! Today was the day I would sink or swim, success or an inglorious disaster. What had I been thinking to attempt to run a Mass Casualty drill when I’d never even seen a mass casualty event in real life?
MSF goes where the action is; cholera, floods, earthquakes, fighting. Every team has to be prepared for an overwhelming number of patients to arrive at once, which is called a mass casualty event. Part of my new job on this mission is to ensure that the entire team is prepared, knowing their role, the equipment ready. To me, medicine is a ‘hands-on sport’ not an armchair event that you learn by watching a power-point. I felt that in order to truly understand what we were, or were not prepared for, we needed to implement a disaster event with thirty of our outreach staff playing the role of injured patients, family and community members. It would be an opportunity to test our system for weaknesses and to give the staff a chance to try out their roles, to see what additional teaching would be needed.
Preparing the team for the mass casualty drill.
Fortunately, I have two dynamic and experienced French emergency physicians on the team, both having worked with real mass casualty events in Pakistan, the Philippines and Central African Republic. Dr. Aurelie Lechevrel spent hours working on the format for our drill, training observers what to look for, creating checklists to probe for weaknesses and reviewing with the nurses what their role as players would be. Our pharmacist, Michaela Posch from Austria set up the scenario, teaching the community health workers what victim roles they were to play. Logistics were involved moving supplies and providing stretcher-bearers and drivers to transport the casualties.
Joel and Musa, two community health workers, preparing for their roles.
The morning flew by as we quickly finished rounding on our real patients, preparing them to understand what was about to happen. At 12:30, the first ‘victim’ stumbled into the door, clutching an injured arm and shouting about an accident with one of the United Nations buses that moves incoming refugees. It was show time!
As Medref, I needed to announce the Mass Casualty, calling on the radio to our Project Coordinator (PC), who, in a real event, would inform the rest of the team, forward the information to our coordination team in the capital city and alert the community leaders. Within minutes, the cleaners and drivers were moving our mass casualty boxes into position while the nurses were pretending to clear the hospital of any patients well enough to go home.
A pretend victim being carried in to the compound.
More ‘victims’ arrived, and Dr. Marie Freichet and her team of nurse consultants, nurses and assistants quickly sorted the players according to their injuries. Those needing immediate care with a good chance of surviving were triaged to our Red tent where Aurelie and her team were standing by to provide critical care. Those less injured were sorted to our Yellow Zone where Ahmed Mohamed Mahat our Kenyan nurse in charge of outreach and his team were unpacking their Mass Casualty box of supplies while those who could walk and talk were being led to the Green tent where our nurse consultants and nurses would provide care.
Meanwhile one of our MSF ambulances arrived with several victims, the drivers and support staff quickly but carefully unloading patients onto stretchers. Mothers shouted for their injured children, a community leader demanded to know what was going on, and a man with a stick pretending to be a gun tried to fight his way in for care. It was controlled pandemonium.
Maki Ahmed tries to argue his way into the compound
“Lanice, do I need to ask Coordination to send a surgical team?” the radio crackled as our PC asked for an update.
“We can call in our partners from the local surgical team,” I replied, as I did a quick headcount and determined that local resources could manage the influx.
Ahmed, Mohamed and Mahat
By two hours the patients had been sorted, received appropriate care and I declared that the mass casualty event was declared over. We met as a team, seventy strong, with every player, victim and observer filling out a questionnaire to understand areas that worked well and areas needing improvement. We shared cookies and cold water chattering and laughing as the tension lifted. While there were clearly areas needing an improvement in supplies and education, overall it had been an outstanding success, a huge learning opportunity for all of us. And best of all, I’d survived my first MCP!