The mass casualty event discussed here is the mass shooting in Las Vegas that happened in 2017. This was a terrorist attack when a lone ranger opened fire on a mass of people in a concert at the Route 91 Harvest music festival. This was one of the worst shooting massacres in US history happening on the busy Las Vegas Strip in Nevada that resulted in the death of 58 people and more than 800 people injured. For this festival, the Clark County fire department, Las Vegas metropolitan police department and onsite security were all in communications ( Smith, Simpson & Heightman, 2018) . Community’s ambulance personnel including EMS personnel were available and positioned in strategic positions within the venue. Ambulances were also available and strategically parked near the venue’s medical tent.
Once the incident struck, the disaster plan and incident command system training and planning process of Clark Country was developed. The organizers adopted a formalizes ICS process after the shooting had stopped to obtain information from law enforcement. Off-duty ambulance personnel would then assume on-duty status to take care of victims. In this incidence, there were no first responders as the team had prepared and therefore responded from within the place ( Smith, Simpson & Heightman, 2018) . However, the number of injured victims overwhelmed on-scene medical supplies and exhausted stores. After the shooting stopped, a command structure was put in place to coordinate the rescue plans by establishing triage and transport. The traffic had to be controlled and enable transport of victims to nearest hospitals. The community ambulance did not use triage tags at this event due to active shooting going on, though they placed abandoned hats over the faces of the deceased to indicate victims were dead.
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Since mass casualty events are involved, first responders must be ready to take on, triage, treat and transport patients immediately upon arrival and those coming later may be required to set up formal triage, patient collection and treatment areas. The commanding officer should then radio for additional resources whenever they experience mass casualty incidence. The resources needed for large-scale casualty incident include blood transfusion to help in case of urgent blood appeal for the victims. The command central should request for tourniquets to stave off severe bleeding, replace fluids and immobilize trampled limbs. The additional resources may be in the form of more ambulances and initiating more police and fire personnel from multiple agencies.
In this event, it is better to use simple triage model for initial field triage and a dual command structure once patients have reached the hospital, where one physician is in the emergency department and another directing the flow in the operating room. A simple triage and rapid treatment model are used to track all patients to tag patients based on the severity of the injury to deal with insufficient resources ( Ritter, Price & Cano, 2018) . This system helps determine who is most urgent in need of transportation to a hospital for care. Patients can be classified as high acuity or less acuity depending on how they are likely to benefit from alternative care approaches.
Unity of the respondents is also crucial when dealing with such cases of mass casualties. There is also the importance of interagency relationship when handling complex mass casualty events since the ability to allocate resources and organize an effective response on a mass casualty event depends on flexible and integrated communication systems. A command center equipped with multiple uninterrupted radios enables this integration and continuous feedback ( Ritter, Price & Cano, 2018) . Errors in communication in the field can result in several patients miss-triaged, which necessitates the need to maintain 9-1-1 coverage and all other lines of communication to assist in informing the hospital about incoming patients.
Educating, equipping and empowering the public could help save additional lives during a mass casualty incident. Intra-agency and tactical training is necessary for large-scale conflicts between the fire department, medical facilities and the police can help whenever planning for such events. EMS agencies, emergency responders and hospitals are critical to a community during an MCI where they have to work together to manage the development. At the same time, the personnel should be educated on safety interacting and treating people with post-traumatic stress disorder ( Ritter, Price & Cano, 2018).
In conclusion, innovative planning, preparation and collaboration are crucial in mitigating some impacts of MCI. The Las Vegas MCI was an example of terrorism explaining how the size and rate of mass casualty events have increased. The first thing is therefore to solidify interagency cooperation, communications, and reimbursement. After that, the triage treatment and transport protocol for MCIs should be developed. A third opportunity is to enhance alternative care options for low-acuity MCI victims who cannot be transported to the health facility.
Refences
Ritter, K., Price, M. L., & Cano, R. G. (2018, August 28). Report: Communications Overwhelmed in Las Vegas Mass Shooting. Retrieved from https://www.jems.com/articles/news/2018/august/report-communications-overwhelmed-in-las-vegas-mass-shooting.html
Smith, J., Simpson, G., & Heightman, A. J. (2018, April 1). EMS Response to the Mass Shooting at the Route 91 Harvest Festival in Las Vegas. Retrieved from https://www.jems.com/articles/print/volume-43/issue-4/features/ems-response-to-the-mass-shooting-at-the-route-91-harvest-festival-in-las-vegas.html
