Sunday, May 18, 2008

Spending the weekend in burned out buildings

What is an acrophobe doing leading a team down an almost totally black stairwell, one with walls but no railings on either side, in a burned out building? I'm glad you asked. Since I had gone up an almost totally black stairwell leading a team, we all kinda wanted to go back the other way. I had no flashlight, altho some of my team members did. I've never done live D&D, but the many times I had played on paper had instilled certain habits. Like walking with a hand on one or both walls. Testing the floor before putting my full weight on it. I found the door when the guys with the flashlights passed right by. Taking nothing for granted. And tell the helpful guy behind me to stop trying to be helpful and point the freakin' flashlight somewhere else. It was easier to go down the pitch black stairwell completely blind than it was with two flashlights putting strange shadows and shapes on the stairs. Twitchy, moving shadows.

It was CERT refresher weekend here in the sunny city of Long Beach, California. I was in the urban search and rescue segment, checking out a four-story building for victims. The previous segment was SAR in a one-story building, for which I had been scribe. That meant I got to record the injured "victims" brought out of the building, one of whom had been drafted with no instructions. When I asked for injuries, he looked at me blankly and said, "They didn't tell me." Right, delusional, send him to Urgent. In the four-story segment, I ended up being scribe again. I asked the fireman trainer if I could go in the building later, as I hadn't been in one. He then drafted himself as scribe, and I got to lead a team. My team, lucky people that we were, got the third and fourth floors of the four story building. And everybody got to follow someone who does not like stairs up and then back down three flights of stairs, slowly and carefully.

When we first arrived, there was a short segment of Opening Ceremonies, mostly reiterating why we were here: to practice what to do during and after emergencies, which included taking care of us first, then victims. We were to rescue victims, not become one. The fireman in charge of first aid said if anyone failed to take care of him/herself, and in the expected heat, that meant hydration hydration hydration, the person would be treated, and then the fireman would kick them in the butt. It was said to us in every segment, at every opportunity, that we must take care of us first. We can't take care of anybody else if we become victims.

When we signed in, we were given wrist bands of various colors. There were eight 45-minute segments; the order we took them was determined by the color. Beth, my best friend and CERT buddy, and I got Disaster Preparedness right off. We could have taught the course. Not necessarily better, but we didn't learn much. One thing we learned was that the Red Cross lady teaching it had never seen an MRE. Three of us tore open our backpacks/kits and pulled ours out. Beth and another guy had the full package, and explained the differences between civilian and military MRE packages. The military has a better eating utensil and has some additional things like toilet paper and chewing gum. I just carry the main dishes. I have to feed a sugar-sensitive person and therefore don't carry the rest of an MRE pack, which is often things full of sugar. Since there's a chance he may grab and eat without thinking, there are no sugar-filled things in the three-day pack. There is no way I want to deal with a sugar-charged guy when I'm also trying to cope with an emergency. And yes, MREs taste good. They aren't cordon bleu cooking, but they're not bad. They're edible in an emergency without wanting to go "ewwwww."

The next segment, Triage, taught me right off that I need to repack my kit. I know I have a pen in there somewhere, but damn if I could find it. Same with the above flashlight I didn't have. (It probably took advantage of my digging for the MRE to dive for the bottom of the kit.) If I have to be scribe for triage, I can't be huntin' for a pen. The firemen overseeing this exercise were quite pleased with our group. We'd cleared the field of "injured," sorted into the medical area in less than 20 minutes, and only misdiagnosed one. The various "victims" had been annointed with "blood," had a half-sheet of paper with "symptoms," had an assortment of prosthetic wounds strapped on, and generally had a hard time keep a straight face as we all poked and prodded them. Later, we heard from another group who said some of their triage victims were lying on the sheet of paper with symptoms, so the CERT team had to wing it. We identified and marked various levels of injuries, then cleared the field of victims, walking wounded walk out on their own, then urgent, not life threatening, and then dead. We were supposed to drag our dead guy to the morgue area, but we made him get up and walk.

Then we got to be Medical. Because Beth had some EMT training, we got stuck with a red tarp, meaning we got the urgent cases. (For those playing at home, in mass injury incidents, areas are designated, and colored tarps are used when you have them to easily identify: Red - Urgent/Dead without medical help NOW, Yellow - Not Life Threatening, Green - Banged and Scraped.) And again, I was scribe. We were told that we'd be getting some victims who hadn't gone thru triage, so we'd have to triage them in Medical. Since the red tarps were closest to the incident site, we got the first one. Open break, what used to be called a compound fracture, of his right arm. He got splinted and wrapped and bandaged within an inch of his life, because we didn't have any other victims at the time. We then got a little old lady with "chest pains." The lady as herself had to sit in a chair, which caused a bit of confusion a bit later when someone walked up and said, "She should be lying down." In reply, he got a chorus of "she is." We were treating her, or trying to treat her, as if she was lying down. Our third victim was a trauma nurse in real life. Which explained why she could replicate the symptoms so well, nausea, coffee-ground vomiting, new and wonderful pains that showed up, etc. We chatted at lunch and found that she was playing a ruptured spleen and something ugly to do with the liver.

Meanwhile, the other red tarp had a screamer. A rather large, athletic guy had been roped in to be a victim who wanted to find Susy, and was extremely resentful of anyone who wanted to tend his injuries. So resentful that at one point, he had two other guys lying on him, trying to hold him down. Better them than me.

I discovered that I should write each victim on a separate page, as victims in the Urgent section had a nasty tendency to add symptoms as we went along. The heart attack lady "stopped" having a pulse at one point, and had to have CPR. We "saved" a life, as her heart "started" again. I wandered over to our broken arm guy, who had initially been slated to go to the yellow tarp once we bandaged him, but was upgraded to urgent when he added dizzyness to his previous light-headedness, and low spinal back pain to his collection of "injuries." He was chatting with one of the firemen overseeing the exercise. I told him he was going to have to play victim again, as I was there to check on him. Life got a bit more interesting when two of the yellow-tarped people got upgraded to urgent. Our team leader decided that they shouldn't be moved, the first, with a head injury, because she was blanketed and comfortable, and didn't need to add to her trauma by moving, and the second because she was a neck injury, who just didn't need to be moved until the paramedics took her away. So now I'm running back and forth between our red tarp and the yellow tarp, tracking changes. The field had been cleared of injured, we were dealing with our last arrival, and starting on prioritizing for transport when the exercise ended. During the triage segment, our team reported to the IC regularly. In Medical, I saw him once. I asked if that was correct, as I all my time was sucked up by tracking changes in our patients. The firemen and the guy who was IC told me I did the right thing. If the IC wanted to talk to me, he could find me.

That was fun. No, really, it was. Beth and I found out we work great as a team. She does medical really well. And I do honest patient reassurance very well. Having been a patient in tremendous pain, I don't want someone telling me I'm ok. If you're going to lie to me on something I know is wrong, what else are you going to lie about? So my patients got variations on no, you're not ok, but you will be. My most difficult reassurance was the head-injury victim who'd lost her ability to speak or understand english, if she'd ever had it. She only spoke in japanese, and I was left with patting and holding her shoulder and repeating "OK?" a couple of times. She was coherent enough to manage "OK" back at me. It had an upside in that the person who'd treated her and I could discuss symptoms and secondary assessment in a light tone without freakin' the patient.

Next we got to talk with the USR people, Urban Search and Rescue. Why aren't they USAR? Because the US Army Reserve claims those initials. The USR guys told us what they did, which is everything from helping in multi-car accidents to whitewater rescue (we don't get a lot of rain here, but when we do, our little trickling rivers turn into whitewater monsters-think flash flood). Because Long Beach has a substantial harbor area, they do a lot of rescues in the port area, ranging from longshoremen trapped under equipment to longshoremen crushed under those huge cargo containers. They showed us their "tool box," a truck as long as the largest hook-and-ladder truck I've seen, full of hand tools, power tools, generators, air compressors for refilling air tanks, 2x4 and 2x8 to prop up collapsing building long enough for SAR to find victims and evacuate them, and just an amazing array of things for breaking stuff up or holding stuff together. Our guide said the busiest guy during the Paradise fire was the engineer, refilling air tanks. Another of his stories was interesting in the insights it gave into thinking outside the box. They couldn't get the truck in close, so hooked a firehose to the jackhammer air compressor and ran it out 300 feet from the truck to power the jackhammer.

Next was lunch. The Long Beach fire department put up several shade areas, so we could rest and eat out of the direct sun, but it didn't help with the overall heat. We were all very glad the event was being held in Long Beach, because it "only" got to the mid 80s. The San Fernando Valley was up around 102-105. It's only mid-May. What is the summer going to be like? *bleh*

After lunch and the above mentioned SAR, we learned how to improvise things to pry and prop up fallen things so we could get people out from under those fallen things. Mostly it was standing under awning, discussing the hows and whys of this process. Then we got to stand or kneel in the sun for a bit, while we built Lincoln-log type structures to pry up and then hold up a car, so someone could drag the victim out from under. By this point, the victim dummy had been dragged back and forth so much (we had to put him back under the car when we were done), his clothes were coming off and his torso was showing a bit of wear. We had a couple of primarily Spanish speaking people in our group, so we also got to learn how to give very simple directions understood by all.

Then we got to play with fire extinguishers. My first extinguisher lasted long enough for me to get within shootin' distance of the fire before it stopped extinguishing. Add it to the dead pile. Beth and I went back around and got a totally unused extinguisher, stood in line, and when it was our turn, tested the extinguisher before moving to the fire. The extinguisher didn't work at all. Add that one to the dead pile and try again. The third one did its test blast well, we moved in on the fire, put it out. But the extinguisher wouldn't turn off. The fireman supervising told me to back away from the fire area and let go of the handle. I said, it won't turn off. He came over and took it away from me, body language saying he will now show this trainee how it's... wait, this extinguisher won't turn off. Cool, guy, now it's your problem. The thing finally ran out of juice and got added to the dead pile. The fireman said we could try again. I said I've tried three extinguishers and they all broke one way or another. I'm not dealing with another one. On top of that, the wind was swirling. The fireman kept repeating, "Approach from the upwind side. Approach from the upwind side." You tell me which side will be the upwind side when I get there, and I'll approach from that side. Nope. Today is not my day for fire extinguisher duty.

By this point, it's late in the day, my feet hurt from standing on them most of the day (I'm a desk jockey most days), and I'm covered in grime and sweat (I'm an inside desk jockey). My thirty pound backpack full of food, water, medical supplies and CERT gear now weighs at least a hundred pounds. And the half dozen chairs in the shade already have people in them. So I sat on the ground. Which meant when that segment was over, I had to clamber all the way back up, not just stand up out of a chair. urf

Fortunately, this last segment was ICS and held indoors. In airconditioned indoors, where my grime and sweat turned into grime and salt. I could listen to ICS trainers all day. Being an IC is the part that scares me the most about being a CERT member. In an emergency, I'm it. No group who at least have taken CERT classes and have a partial clue. I'm going to be organizing civilians. Boy, does that give me sympathy with LEOs and other emergency personnel. Beth agreed, and said even after doing it in a real emergency, it's still the scariest part. She spent ten years in Tampa, Florida, picking up after hurricanes.

The trainer in this segment was great. In a lot of normal classroom situations, you have a "right" answer. Our fireman trainer said there is no right answer in emergencies. There are only choices made based on what we know at the time, which includes the training we have. One scenario was of a two story house, smoke coming from the back. When the view shifted to the back, there was fire visible in an upper window. As we discussed what we would do, the trainer added smoke from the other side of the house, and smoke coming from the attic. The trainer said for fireman, this house fire was routine to them. What would be a "don't go in" second floor area to a CERT member would only be a "proceed with caution" area to a fireman. What would be a "proceed with caution, if at all" first floor to CERT would be a routine no problem area for firemen. One scenario was a fire on or between two tanker cars in a train switching yard. Behind it was a couple of large storage tanks in an oil refinery. I said, "Ohh Shit." The trainer said I was the first person to say that all day. Either everybody else was too polite, or I was too tired to be politely quiet. Or I remember too many refinery explosions from my childhood. What does a CERT member do in that situation? Call 911 and get the heck outta there. Potential explosion, potential hazmat, potential so out of our league, after calling 911, one of the group said call 1-800-HaulButt.

ICS has a number of segments to it, and not all of them are necessary at every incident. Like finance/banking. The fire department needs to consider money when they have a lot of what they call "metal in the air" (firefighting planes, helis) which cost anywhere from $30k to $100k an hour (yes, an hour) to operate. CERT people aren't working with those kind of numbers and mostly don't need to worry about how to pay for stuff. Our trainer got us thinking about what CERT people need to worry about in different scenarios: status of utilities, SAR, supplies. We missed part of the event's closing remarks because we kept asking our ICS trainer questions. I could have sat thru another hour or more of that class.

At the end of class, I picked up my thirty pound turned hundred pound kit that somewhere gained another fifty pounds, and staggered with the rest of the group over to closing ceremonies. All the primary instructors were pleased with us, and were pleased that, even with the heat, we'd stayed hydrated and took care of ourselves. We'd only had one casualty among the CERT people. I got my one last look at all those fit, athletic firemen (one of the perks of having CERT affiliated with the fire department!), staggered out to the carpool van, and toddled on home.

This morning, I was a bit stiff and sore, but not too badly, and my touch of sunburn was still a bit pink but would probably turn into tan by tomorrow. Beth is annoyed, as she has pale skin that burns, peels, and stays pale. Her sunscreen application held up quite nicely, and she didn't get too much sun. I'm now off to find the flashlight I know I have in that kit, add a couple more pens, and generally set things up so I can find what I need in a hurry a bit more quickly. Personal protective equipment, flashlight, marking and writing tools, gotta be on top. And stay there. Bandages and medical supplies next. After that, well, it depends on what I learn in the next refresher, six months from now. With luck, not from an emergency in the meantime.

1 comment:

Beth said...

Ye gods. Firemen wandering all over the place looking gorgeous and handing out cold bottles of water. Disaster supplies, about 300 like-minded people and a display of antique (circa 1920's) fire trucks.

Yes, it was a good day.